Health Environment Management Agency

Hanoi, Vietnam

Health Environment Management Agency

Hanoi, Vietnam
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Khieu T.Q.T.,University of Otago | Khieu T.Q.T.,Health Environment Management Agency | Pierse N.,University of Otago | Telfar-Barnard L.F.,University of Otago | And 3 more authors.
Journal of Infection | Year: 2017

Objectives: Influenza is responsible for a large number of deaths which can only be estimated using modelling methods. Such methods have rarely been applied to describe the major socio-demographic characteristics of this disease burden. Methods: We used quasi Poisson regression models with weekly counts of deaths and isolates of influenza A, B and respiratory syncytial virus for the period 1994 to 2008. Results: The estimated average mortality rate was 13.5 per 100,000 people which was 1.8% of all deaths in New Zealand. Influenza mortality differed markedly by age, sex, ethnicity and socioeconomic position. Relatively vulnerable groups were males aged 65-79 years (Rate ratio (RR) = 1.9, 95% CI: 1.9, 1.9 compared with females), Māori (RR = 3.6, 95% CI: 3.6, 3.7 compared with European/Others aged 65-79 years), Pacific (RR = 2.4, 95% CI: 2.4, 2.4 compared with European/Others aged 65-79 years) and those living in the most deprived areas (RR = 1.8, 95% CI: 1.3, 2.4) for New Zealand Deprivation (NZDep) 9&10 (the most deprived) compared with NZDep 1&2 (the least deprived). Conclusions: These results support targeting influenza vaccination and other interventions to the most vulnerable groups, in particular Māori and Pacific people and men aged 65-79 years and those living in the most deprived areas. © 2017 The British Infection Association.


Phung D.,Griffith University | Rutherford S.,Griffith University | Chu C.,Griffith University | Wang X.,CSIRO | And 5 more authors.
Occupational and Environmental Medicine | Year: 2015

Background The Mekong Delta is the most vulnerable region to climate change in South-East Asia; however, the association between climate and children's health has rarely been studied in this region. Objective We examined the short-term association between daily temperature and hospital admissions for all causes, gastrointestinal and respiratory infection, among young children in the Mekong Delta area in Vietnam. Methods Daily paediatric hospital admissions and meteorological data were obtained from January 2008 to December 2012. A time-series approach was used with a combination of a Poisson regression and constrained distributed lag models to analyse the data. The long-term and seasonal trends, as well as other time-varying covariates, were adjusted using spline functions. Temperature - pediatric admission relationship was evaluated by age-specific (0-2 and 3-5-year-olds) and cause of admission groupings. Results A 1°C increase in the 2-day moving average temperature was significantly associated with a 3.4% (95% CI 1.2% to 5.5%), 4.6% (95% CI 2.2% to 7.3%), 2.6% (95% CI 0.6% to 4.6%), 4.4% (95% CI 0.6% to 8.2%) and 3.8%(95% CI 0.4% to 7.2%) increase in hospital admissions with 0-2-year-old children, 3-5-year-old children, all causes, gastrointestinal infection and respiratory infection, respectively. The cumulative effects from 1-day to 6-day moving average temperature on hospital admissions were greater for 3-5-year-old children and gastrointestinal infection than for 0-2-year-old children and other causes. Conclusions Temperature was found to be significantly associated with hospital admissions in young children with the highest association between temperature and gastrointestinal infection. The government agencies of Mekong Delta should implement measures to protect children from the changing temperature conditions related to climate change.


Phung D.,Griffith University | Phung D.,Health Environment Management Agency | Huang C.,Griffith University | Huang C.,Sun Yat Sen University | And 6 more authors.
Acta Tropica | Year: 2015

The Mekong Delta is highly vulnerable to climate change and a dengue endemic area in Vietnam. This study aims to examine the association between climate factors and dengue incidence and to identify the best climate prediction model for dengue incidence in Can Tho city, the Mekong Delta area in Vietnam. We used three different regression models comprising: standard multiple regression model (SMR), seasonal autoregressive integrated moving average model (SARIMA), and Poisson distributed lag model (PDLM) to examine the association between climate factors and dengue incidence over the period 2003-2010. We validated the models by forecasting dengue cases for the period of January-December, 2011 using the mean absolute percentage error (MAPE). Receiver operating characteristics curves were used to analyze the sensitivity of the forecast of a dengue outbreak. The results indicate that temperature and relative humidity are significantly associated with changes in dengue incidence consistently across the model methods used, but not cumulative rainfall. The Poisson distributed lag model (PDLM) performs the best prediction of dengue incidence for a 6, 9, and 12-month period and diagnosis of an outbreak however the SARIMA model performs a better prediction of dengue incidence for a 3-month period. The simple or standard multiple regression performed highly imprecise prediction of dengue incidence. We recommend a follow-up study to validate the model on a larger scale in the Mekong Delta region and to analyze the possibility of incorporating a climate-based dengue early warning method into the national dengue surveillance system. © 2014 Elsevier B.V.


PubMed | Griffith University, Health Environment Management Agency and Sun Yat Sen University
Type: | Journal: The Science of the total environment | Year: 2016

The association between heavy rainfall and infectious intestinal diseases (IID) has not been well described and little research has been conducted in developing countries. This study examines the association between heavy rainfall and hospital admissions for IID in Ho Chi Minh City, the most populous city in Vietnam. An interrupted time-series method was used to examine the effect of each individual heavy rainfall event (HRE) on IID. The percentage changes in post-HRE level and trends of IID were estimated for 30days following each HRE. Then a random-effect meta-analysis was used to quantify the pooled estimate of effect sizes of all HREs on IID. The pooled estimates were calculated over a 21day lag period. The effects of a HRE on IID varied across individual HREs. The pooled estimates indicate that the levels of IID following a HRE increased from 7.3% to 13.5% for lags from 0 to 21days, however statistically significant increases were only observed for lags from 4 to 6days (13.5%, 95%CI: 1.4-25.4; 13.3%, 95%CI: 1.5-25.0; and 12.9%, 95%CI: 1.6-24.1 respectively). An average decrease of 0.11% (95%CI: -0.55-0.33) per day was observed for the post-HRE trend. This finding has important implications for the projected impacts on residents living in this city which is highly vulnerable to increased heavy rainfall associated with climate change. Adaptation and intervention programs should be developed to prevent this additional burden of disease and to protect residents from the adverse impacts of extreme weather events.


PubMed | Griffith University, Health Environment Management Agency and Sun Yat Sen University
Type: Journal Article | Journal: Environmental pollution (Barking, Essex : 1987) | Year: 2016

The effects of heatwaves on morbidity in developing and tropical countries have not been well explored. The purpose of this study was to examine the relationship between heatwaves and hospitalization and the potential influence of socio-economic factors on this relationship in Vietnam. Generalized Linear Models (GLM) with Poisson family and Distributed Lag Models (DLM) were applied to evaluate the effect of heatwaves for each province (province-level effect). A random-effects meta-analysis was applied to calculate the pooled estimates (country-level effects) for all causes, infectious, cardiovascular, and respiratory admissions queried by lag days, regions, sex, and ages. We used random-effects meta-regression to explore the potential influence of socio-economic factors on the relationship between heatwaves and hospitalization. The size of province-level effects varied across provinces. The pooled estimates show that heatwaves were significantly associated with a 2.5% (95%CI: 0.8-4.3) and 3.8% (95%CI, 1.5-6.2) increase in all causes and infectious admissions at lag 0. Cardiovascular and respiratory admissions (0.8%, 95%CI:-1.6-3.3; 2.2%, 95%CI:-0.7-5.2) were not significantly increased after a heatwave event. The risk of hospitalization due to heatwaves was higher in the North than in the South for all causes (5.4%, 95%CI:-0.1-11.5 versus 1.3%, 95%CI: 0.1-2.6), infectious (11.2%, 95%CI: 3.1-19.9 versus 3.2%, 95%CI: 0.7-5.7), cardiovascular (7.5%, 95%CI: 1.1-14.4 versus-1.2%, 95%CI:-2.6-2.3), and respiratory diseases (2.7%, 95%CI:-5.4-11.5 versus 2.1%, 95%CI:-0.8-1.2). A non-significant influence of socio-economic factors on the relationship between heatwave and hospitalization was observed. This study provides important evidence and suggests implications for the projected impacts of climate change related extreme weather. Climate change adaptation programs of the health sector should be developed to protect residents from the effects of extreme weather events such as heatwaves in Vietnam.


Ngo A.D.,University of South Australia | Ngo A.D.,University of Queensland | Rao C.,University of Queensland | Hoa N.P.,Hanoi Medical University | And 3 more authors.
BMC Public Health | Year: 2012

Background: Road traffic injuries (RTIs) are among the leading causes of mortality in Vietnam. However, mortality data collection systems in Vietnam in general and for RTIs in particular, remain inconsistent and incomplete. Underlying distributions of external causes and body injuries are not available from routine data collection systems or from studies till date. This paper presents characteristics, user type pattern, seasonal distribution, and causes of 1,061 deaths attributable to road crashes ascertained from a national sample mortality surveillance system in Vietnam over a two-year period (2008 and 2009). Methods: A sample mortality surveillance system was designed for Vietnam, comprising 192 communes in 16 provinces, accounting for approximately 3% of the Vietnamese population. Deaths were identified from commune level data sources, and followed up by verbal autopsy (VA) based ascertainment of cause of death. Age-standardised mortality rates from RTIs were computed. VA questionnaires were analysed in depth to derive descriptive characteristics of RTI deaths in the sample. Results: The age-standardized mortality rates from RTIs were 33.5 and 8.5 per 100,000 for males and females respectively. Majority of deaths were males (79%). Seventy three percent of all deaths were aged from 15 to 49 years and 58% were motorcycle users. As high as 80% of deaths occurred on the day of injury, 42% occurred prior to arrival at hospital, and a further 29% occurred on-site. Direct causes of death were identified for 446 deaths (42%) with head injuries being the most common cause attributable to road traffic injuries overall (79%) and to motorcycle crashes in particular (78%). Conclusion: The VA method can provide a useful data source to analyse RTI mortality. The observed considerable mortality from head injuries among motorcycle users highlights the need to evaluate current practice and effectiveness of motorcycle helmet use in Vietnam. The high number of deaths occurring on-site or prior to hospital admission indicates a need for effective pre-hospital first aid services and timely access to emergency facilities. In the absence of standardised death certification, sustained efforts are needed to strengthen mortality surveillance sites supplemented by VA to support evidence based monitoring and control of RTI mortality. © 2012 Ngo; licensee BioMed Central Ltd.


PubMed | Griffith University and Health Environment Management Agency
Type: Journal Article | Journal: International journal of biometeorology | Year: 2016

Flooding causes significant public health issues. The Mekong Delta has been considered the region to be the most vulnerable to flooding in Vietnam. This study assessed the spatial vulnerability of the health impacts of flooding in the Mekong Delta region, Vietnam. This study applied a vulnerability assessment framework which was computed as the function of three dimensions: exposure, sensitivity, and adaptive capacity. The indicators for each dimension were derived from the relevant literature, consultations with experts, and data availability. An analytic hierarchy process (AHP) and a principal component analysis (PCA) were used to determine the weight of indicators. Vulnerability indexes (VIs) were then computed for each province. A total of 29 indicators (sensitivity index, 14; adaptive capacity index, 13; and exposure index, 2) were employed to evaluate the vulnerability to the health impacts of flooding at a provincial level. The results of AHP revealed that the highest VIs were found in the Dong Thap and An Giang provinces (VI, 1.948 and 1.574, respectively). VIs were distributed with higher indexes in upstream provinces close to a river than in coastal provinces. PCA generated three components from the 29 indicators, and the VIs computed from the PCA method are in substantial agreement with the AHP method (ICC=0.71, p<0.05). The vulnerability to the health impacts of flooding varies from province to province in the Mekong Delta region in Vietnam. Individual plans for health preparedness and adaption to flooding should be developed for each province in the Mekong Delta region.


PubMed | Griffith University and Health Environment Management Agency
Type: | Journal: The Science of the total environment | Year: 2017

This study examined the temporal and spatial patterns of hand, foot, and mouth disease (HFMD) in the Mekong Delta region in Vietnam. A time-series analysis was used to examine the temporal patterns of HFMD in relation to climate factors while a retrospective space-time scan was used to detect the high-risk space-time clusters of this disease. A 1C increase in average temperature was associated with 5.6% increase in HFMD rate at lag 5days (95% CI 0.3-10.9). A 1% increase in humidity had equal influence of 1.7% increases on HFMD rate at both lag 3days and 6days (95% CI 0.7-2.7 and 95% CI 0.8-2.6, respectively). An increase in 1 unit of rainfall was associated with a 0.5% increase of HFMD rate on the lag 1 and 6days (95% CI 0.2-0.9 and 95% CI 0.1-0.8, respectively). The predictive model indicated that the peak of HFMD was from October to December - the rainy season in the Mekong Delta region. Most high-risk clusters were located in areas with high population density and close to transport routes. The findings suggest that HFMD is influenced by climate factors and is likely to increase in the future due to climate change related weather events.


Khieu T.Q.T.,University of Otago | Khieu T.Q.T.,Health Environment Management Agency | Pierse N.,University of Otago | Telfar-Barnard L.F.,University of Otago | And 2 more authors.
Vaccine | Year: 2015

Background: Influenza has a substantially but poorly measured impact on population health. Estimating its true contribution to hospitalisations remains a challenge. Methods: We used simple and comprehensive negative binomial regression models with weekly counts of hospitalisations and isolates of influenza A, B and respiratory syncytial virus for the period 1994- 2008. Results: The estimated annual national average number of hospitalisations attributable to influenza was 822.1(95% CI: 815.3, 828.9) for pneumonia and influenza, 1861.3 (95% CI: 1842.9, 1879.7) for respiratory illness, 12.1 (95% CI: 2.6, 21.6) for circulatory illness, 2260.0 (95% CI: 2212.2, 2307.8) for all medical illness and 2419.9 (95% CI: 2356.4, 2483.4) for all causes. The contribution of influenza to total hospitalisations was about nine times larger than indicated by routine discharge data. New Zealanders 80 years of age and older had the highest annual excess rates of influenza-related hospitalisations (327.8 per 100,000); followed by infants under 1 year (244.5 per 100,000). Estimated influenza hospitalisation rates were also markedly higher in Pacific (83.3 per 100,000) and Māori (80.0 per 100,000) compared with European/Others (58.1 per 100,000). Respiratory illness was the major contributor to all cause hospitalisations attributed to influenza accounting for 77%. Influenza hospitalisations included only a negligible contribution from circulatory illness. Conclusion: These findings support efforts to reduce the impact of influenza, particularly for the most vulnerable population groups highlighted here. Analysis of the cost-effectiveness of such interventions needs to consider these higher modelled estimates of disease impact. © 2015 Elsevier Ltd.


Nguyen N.P.,World Health Organization | Passmore J.,World Health Organization | Tran L.T.N.,Health Environment Management Agency | Luong A.M.,Health Environment Management Agency
Traffic Injury Prevention | Year: 2013

Objective: To assess the blood alcohol concentration (BAC; dependent variable) of patients with road traffic injuries (RTIs) presenting at 3 provincial and central hospitals in the Socialist Republic of Viet Nam by age, sex, and road user type (independent variables). This survey formed part of the Viet Nam Road Traffic Injury Prevention Project, funded by Bloomberg Philanthropies.Introduction: RTIs are a leading cause of death and disability in Viet Nam, with 14,690 deaths and 143,940 injuries reported by the Ministry of Health (MOH) in 2010. Research estimates suggest that motorcycle riders and passengers account for 60 percent of fatalities. Alcohol has long been suspected of being a leading cause of road traffic collisions and injuries. However, until now data on this relationship have been limited.Methods: A descriptive cross-sectional study measuring BAC in all consenting patients with RTIs presenting at 3 provincial or central hospitals between July 2009 and September 2010. All results were anonymous and summary information on key variables was sent to MOH and the World Health Organization (WHO) on a monthly basis.Results: Of the 36,418 patients with RTIs presenting to these 3 hospitals between July 2009 and September 2010, BAC analysis was completed on 14,990 patients (41.2%), representing all patients with RTIs 15 years of age and above who consented to anonymous testing. BAC results ranged from 0 to 0.589 g/dL blood, with a mean of 0.0441 g/dL being the average concentration among all tested patients. Of all patients tested, 56.8 percent had no detectable alcohol in their system. Motorcycle riders were most commonly represented in the tested sample (70.7%), with 27.8 percent having a BAC above the legal limit (0.05 g/dL). Car or other vehicle drivers represented 2.7 percent of the sample, with 63.4 percent tested having a BAC above 0 g/dL, the legal limit for these road users.Conclusions: The results of this preliminary study indicate that 29.1 percent of all car drivers and motorcycle riders presenting at hospitals with RTIs exceeded the legal BAC limit for operating a motor vehicle. Though further study is required, this is suggestive that strengthening the enforcement of drink-driving laws is an urgent national road safety priority. © 2013 Copyright Taylor and Francis Group, LLC.

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