Depression and associated factors among older people in Vietnam: Findings from a National Aging Survey

BACKGROUND

Depression is one of the most common mental health disorders among older people. Depressive symptoms are often overlooked and untreated in primary care settings. This study aims to assess the prevalence of depressive symptoms and associated factors among older people in Vietnam.

METHOD

The study analyzed data from the Vietnam National Aging Survey (VNAS) conducted in 2022 with a nationally representative sample of 3,006 older people aged 60 and over in 12 provinces. The 15-item Geriatric Depression Scale (GDS-15) was used to assess depressive symptoms. Bivariate and multiple logistic regression analyses were used to explore the association between depressive symptoms and other related factors such as sociodemographic and economic characteristics, social support, health status, Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) limitations, chronic diseases, cigarette smoking status, alcoholic drinking, and domestic violence.

RESULTS

The prevalence of depressive symptoms among older people was 20.2%. The associated factors that increase the odds of having depression among older people were female gender (OR = 2.21, 95% CI 1.34-3.62), living in rural areas (OR = 1.83, 95% CI 1.15-2.89), the poorest quintile (OR = 2.26, 95% CI 1.39-3.66), self-rated poor health (OR = 11.68, 95% CI 4.96-27.49), ADL limitations (OR = 2.12, 95% CI 1.51-2.99), IADL limitation (OR = 1.61 95% CI 1.16-2.25), and experiencing domestic violence in the last 12 months (OR = 6.66, 95% CI 4.00-11.05).

CONCLUSION

Depression symptoms were prevalent among older people in Vietnam. Depression screening for older people should be included in primary care settings for early identification and treatment of depression.

Unmet needs for care for activities of daily living among older adults with functional disabilities in Vietnam

Background

Given its low-middle-income status, Vietnam is experiencing a rapidly aging population. Along with this demographic trend, the care needs of older adults, particularly those with functional disabilities, have become an emerging policy issue.

Purpose

This study examined the prevalence of unmet needs for care in activities of daily living (ADLs) among Vietnamese older adults with functional disabilities.

Methods

We used data from the Population Change and Family Planning Survey (PCS) in 2021, which was a nationally representative survey. Cross-tabulations and logistic regressions were applied to identify older adults' individual and household factors associated with their unmet care needs.

Results

Overall, 4.80% of older adults with at least one functional disability needing care to perform one or more ADLs suffered from unmet needs, of whom 2.32% did not receive any care and 3.05% received insufficient assistance. Logistic regression results revealed that age, sex, place of residence, ethnicity, marital status, education levels, and self-rated health were significantly associated with unmet needs. The higher risk of having unmet needs is associated with those in middle age (70-79), men, rural residents, ethnic minorities, currently unmarried people, those with less than a primary educational level, and those with normal or poor self-rated health.

Conclusion

Attention should be paid to vulnerable older adults, such as those living in rural areas with poor health status, in order to reduce their unmet needs for ADL assistance.

Patients' Satisfaction with Obstetrics-Gynecology, and Pediatric Healthcare Services in Vietnam: A Multicentre Cross-Sectional Study

PURPOSE

Despite improvements in maternal and child health in Vietnam, sustained efforts are required to improve healthcare quality and resolve persistent disparities, highlighting the universal significance of customer satisfaction in healthcare. This study aims to assess patient satisfaction with healthcare services and associated factors at obstetrics-gynecology and pediatric hospitals across different geographical areas in Vietnam.

PATIENTS AND METHODS

A cross-sectional study was conducted in 2019 among 647 patients or caregivers of hospitalized children at three major obstetrics-gynecology and pediatric hospitals, representing different geographical areas in Northern Vietnam. A Ministry of Health-approved satisfaction instrument was utilized to assess patient satisfaction. The instrument included 31 items measuring five dimensions of perceived satisfaction. Exploratory factor analysis examined the construct validity of the satisfaction measurement, and multivariate linear regression determined the factors associated with patient satisfaction.

RESULTS

Among the 643 participants, 520 were female (89.87%), and nearly half were aged 18-29 years old (43.7%). Factor analysis revealed three dimensions: "Competency and Outcomes", "Accessibility and Procedures", and "Facilities and Equipment", with mean domain scores of 4.6 ± 0.43, 4.28 ± 0.67, and 4.53 ± 0.51, respectively. The proportion of participants completely satisfied with overall service quality was 48.52%, and expectation met was 34.53%. Multivariate linear regression indicated that patients from hospitals in the Red River Delta region had higher satisfaction scores than those in the Middle region across all domains (p<0.05). Higher health insurance coverage was associated with increased satisfaction, while education level, economic status, and ethnicity also influenced satisfaction.

CONCLUSION

The study revealed moderate to high levels of satisfaction among patients at three major obstetrics-gynecology and pediatric hospitals in northern Vietnam. The findings may provide useful evidence for implementing hospital quality control in Vietnam, focusing on patient-centered goals.

Healthcare Services Utilisation and Financial Burden among Vietnamese Older People and Their Households

BACKGROUND

This research examined differences in the utilisation of healthcare services and financial burden between and within insured and uninsured older persons and their households under the social health insurance scheme in Vietnam.

METHODS

We used nationally representative data from the Vietnam Household Living Standard Survey (VHLSS) conducted in 2014. We applied the World Health Organization (WHO)'s financial indicators in healthcare to provide cross-tabulations and comparisons for insured and uninsured older persons along with their individual and household characteristics (such as age groups, gender, ethnicity, per-capita household expenditure quintiles, and place of residence).

RESULTS

We found that social health insurance was beneficial to the insured in comparison with the uninsured in terms of utilization of healthcare services and financial burden. However, between and within these two groups, more vulnerable groups (i.e., ethnic minorities and rural persons) had lower utilization rates and higher rates of catastrophic spending than the better groups (i.e., Kinh and urban persons).

CONCLUSION

Given the rapidly ageing population under low middle-income status and the "double burden of diseases", this paper suggested that Vietnam reform the healthcare system and social health insurance so as to provide more equitable utilisation and financial protection to all older persons, including improving the quality of healthcare at the grassroots level and reducing the burden on the provincial/central health level; improving human resources for the grassroots healthcare facilities; encroaching public-private partnerships (PPPs) in the healthcare service provision; and developing a nationwide family doctor network.

Factors associated with receipt of informal care among the Vietnamese older persons: Evidence from a national survey

Background

The rapidly growing older population in Vietnam poses an increasing need for care among the older persons, who have mainly relied on informal care at homes and communities. This study examined the Vietnamese older persons' individual and household factors determining their receipt of informal care.

Methods

This study provided cross-tabulations and multivariable regression analyses to identify who provided assistance to the Vietnamese older people along with their individual and household characteristics.

Data

The nationally representative survey on older persons, namely Vietnam Aging Survey (VNAS) in 2011 was used in this study.

Results

We found that proportions of older persons having difficulty in activities of daily living (ADLs) were different in regard to their age, sex, marital status, health status, working status, and living arrangements. In care provision, gender differences were clear, in which females generally had significantly higher rates of providing care to older persons than their male counterparts.

Conclusion

Care for older persons in Vietnam has been mainly provided by their families, and thus changes in socio-economic, demographic factors along with differences among generations in family values will be a key challenge to maintain such care arrangements.

Factors Influencing the Vietnamese Older Persons in Choosing Healthcare Facilities

BACKGROUND

The rapidly growing aging population poses major challenges for health systems in Vietnam. This study was therefore aimed to examine factors influencing the choices of healthcare facilities among older patients in Vietnam, using a national survey on older people.

METHODS

We applied multinomial logistic regression models based on Andersen's Behavioral Model with various predisposing factors, enabling factors and healthcare-needs factors associated with different types of healthcare facilities where older patients utilized services.

DATA

We used data from the Vietnam Aging Survey (VNAS) in 2011. This was the first-ever nationally representative survey on older persons in Vietnam.

RESULTS

Among those who used healthcare services, 15.1% visited central hospitals; 23.6% visited provincial hospitals; 28.0% visited district hospitals; 8.8% visited commune heath centres; 18.3% visited private hospitals/clinics; and 6.2% visited other facilities. The results showed that "having to pay cost" and "having sufficient income" were strong predictors for using commune health centres, district hospitals, and private facilities, while "having health insurance" was not a significant predictor for using these facilities. Also, we showed that apart from enabling factors (such as age, gender, educational levels, employment status, living regionand place of residence), predisposing factor (such as health insurance, perceived sufficient income, household wealth and having to pay medical cost) as well as need factors (such as self-rated health and chronic disease) were also associated with the choice of healthcare facilities.

CONCLUSIONS

Based on the findings, we discussed the implications of the results for organizing healthcare finance and delivery to achieve efficiency and equity for older people in Vietnam.

Empirical analysis on the illicit trade of cigarettes in Vietnam

Background

This paper examined how a higher tax on tobacco would affect illicit trade in Vietnam.

Methodology and data

This paper used the gap method to estimate the gap between cigarette domestically tax-paid sales and domestic consumption. Data were from the tax-paid sales by the Vietnam Steering Committee on Smoking and Health (VINACOSH), the Vietnam Tobacco Association, the General Tax Department, as well as two rounds of the Global Adult Tobacco Survey in 2010 and 2015.

Key results

The results indicated that Vietnam had a negative volume of illicit trade, either a result of under-reporting of tobacco use or due to net smuggling of tax-paid cigarettes out of the country. Furthermore, the trend showed an increased negative volume over time, which indicated that increases in tobacco taxes in the interleading years did not result in an increase in illicit trade in tobaccos in Vietnam.

Conclusions

Vietnam’s low prices on domestic cigarettes created favourable conditions for cigarette smugglers and provided easy access to illicit cigarettes for the Vietnamese people, but the absence of a relationship between tax changes and smuggling suggested that potential increases in the excise tax should not be discouraged by the threat of an increase in illicit trade. The government should increase taxes on cigarettes to raise domestic cigarette prices and take strong policy measures to create a more transparent social environment, therefore effectively reducing the prevalence of illicit cigarettes in Vietnam.

Decomposing gender inequality in functional disability among older people in Vietnam

OBJECTIVES

This study compared functional disability in older men and women, and examined the extent to which social determinants contribute to the difference in functional disability between Vietnamese older men and women.

METHODS

A nationally representative sample of persons aged 60 and older in Vietnam, taken from the 2011 Vietnam Aging Survey, was analyzed (N = 2,693, consisting of 1,622 women and 1,071 men). Ordinary least squares regression (OLS) was used to identify factors associated with functional disability in men and women, while Oaxaca-Blinder decomposition for linear models was applied to examine how much of gender inequality in functional disability was attributed by the distribution of the social determinants.

RESULTS

The OLS results showed that functional disability score for women was significantly higher than that for men, and that men and women shared similarity in factors associated with functional disability (e.g., age, educational level, employment status, and perceived sufficiency of income). The decomposition results showed that the distribution of the social determinants explained about 54 per cent of gender inequality in functional disability; among the determinants, age, employment status, and educational level were the major drivers. Approximately 46 per cent of the inequality was explained by unobserved factors.

CONCLUSION

The findings of this study highlight the need for policy to mitigate the social determinants (e.g., education and employment) that contribute to gender inequality in functional disability.

Productive activities of the older people in Vietnam

Productive activities are crucial factors leading to an "active aging" population. With the case of Vietnam, this paper aimed to explore the productive activities among Vietnamese older people by using data from the Vietnam Aging Survey (VNAS), which was conducted in 2011 as the first-ever nationally representative survey on persons aged 50 and over in Vietnam and contained 2789 older people (those aged 60 and over) representing all older people living in 6 ecological regions and urban and rural areas in Vietnam. Productive activities included working and/or taking care of any (great)grandchild(ren) in the past 12 months prior to the survey. Using paired t-tests and probit models, we compared the differences in these productive activities among older people in terms of sex and living area. The results from various t-tests showed that educational attainment, health status and poverty status were key factors differentiating older men and women and rural and urban older people in these productive activities. For the probit estimations in terms of both gender and living location, the results indicated that age, education, health status and supportive children were determinants of working decision, while age, marital status and size of household were consistently important factors of taking care of (great)grandchildren. The paper also discussed policy implications for socio-economic and health protection in promoting older people's productive activities as well as protecting them from a variety of risks and vulnerabilities.

Determinants and impacts of international remittances on household welfare in Vietnam

Remittances can potentially help to promote economic development by providing a mechanism to share risks, reduce poverty and improve equality. However, from the viewpoint of economic theory the overall impacts of remittances are uncertain, as different mechanisms lead to opposite impacts. Since the 1990s Vietnam has experienced a dramatic growth in remittance flows from abroad. Vietnam is a unique case for study, as economic motives historically played a smaller role in outward migration than in other countries. Fortunately, household survey data are available for this time period, allowing for a detailed analysis of the impacts of international remittances on Vietnam. Specifically, we examine the characteristics of recipients and the impacts of international remittances on economic inequality and poverty. We conclude that international remittances are helping to improve equality. For this reason, new development policies must also account for their potential impacts on remittance flows.

Risk factors of HIV infection and needle sharing among injecting drug users in Ho Chi Minh City, Vietnam

OBJECTIVE

We sought to identify risk factors for needle sharing and HIV infection among injecting drug users (IDUs) in Ho Chi Minh City (HCMC), Vietnam.

METHODS

Three cross-sectional surveys among IDUs, both on the street (in 11 urban districts) and in the rehabilitation center for IDUs in HCMC, were carried out in April of 1995, 1997, and 1998. Outreach workers interviewed IDUs about socio-demographic characteristics, drug use and sexual practices, and HIV knowledge and perceptions. The IDUs were also tested for seropositivity to HIV. Independent predictors for HIV positivity and needle sharing were determined by univariate and multivariate logistic regression for the study sample within the rehabilitation center in 1997 and for that on the street in 1998.

RESULTS

The HIV prevalence in 1998 among IDUs was 44% for those on the street and 38.5% for those in the rehabilitation center. Independent predictors for HIV infection in IDUs were being injected by drug dealers (for the 1997 sample), injecting on the street, and sharing the drug pots (for the 1998 sample). The reported rate of needle sharing was low and decreased significantly from 20% in 1995 to 12% in 1998 for the sample of IDUs at the street. In the multivariate analysis, predictors for needle sharing for both study samples were injecting on the street, injecting at shooting galleries, and having shared needles in the past. Adequate and easy access to sterile needles and syringes, and a supportive environment of behavior change, especially in street and shooting gallery could reduce risks of virus transmission in the Vietnamese IDU community.

Treatment of falciparum malaria in Vietnamese children: the need for combination therapy and optimized dosage regimens

To assess the in vivo sensitivity of Plasmodium falciparum to mefloquine and artesunate in a hyperendemic area of southern Viet Nam, we studied 41 children and 21 adults from a remote commune who had uncomplicated falciparum malaria without previous treatment. Patients were randomly allocated to artesunate (4 mg/kg on day 0 and 2 mg/kg on days 1-4) or mefloquine (10 mg/kg followed by 5 mg/kg at 6 h). Serial assessments were performed over 28 days. Of 31 patients allocated artesunate, nine (29%) redeveloped parasitaemia during follow-up compared with 23% (seven of 30) who received mefloquine. Of the 41 children, 15 (37%) had recrudescence/re-infection compared with only one of 20 adults (5%; p < 0.001). Significantly more children than adults failed on mefloquine treatment (37% vs 0%; p = 0.021) and one case showed RIII resistance. There was no significant difference in the case of artesunate. In regression analysis, parasitaemia was an independent predictor of recrudescence/re-infection after mefloquine (p = 0.02). These data support the use of combination therapy such as artesunate plus mefloquine for falciparum malaria in a hyperendemic area of Viet Nam. Primarily because of their greater parasite densities, children should be given higher doses of mefloquine (e.g. 25 mg/kg).

The social context of HIV risk behaviour by drug injectors in Ho Chi Minh City, Vietnam

A combined research approach with both quantitative and qualitative methods was used to contextualize risk behaviour among injecting drug users (IDUs) in Ho chi Minh City (HCMC), Vietnam, in April 1997. A total of 630 IDUs (330 inside and 300 outside the rehabilitation centre) were recruited to the study. Very high-risk injecting behaviour among IDUs in the past, including sharing needles, syringes and drug solutions from the same drug pot in shooting galleries, may explain why HIV prevalence among IDUs in HCM has been growing rapidly. IDUs who had in the past injected on the street, used syringes from shooting galleries, were injected by drug dealers and/or joined in needle sharing were more likely to be sharing needles and syringes currently. Condom use was low, and was mainly with female sex workers but not with regular partners. Both IDUs who continue to use shooting galleries and shooting gallery owners should be educated on the necessity of using clean injecting equipment and on how to clean it properly. Co-ordination between ministries and agencies involved in HIV/AIDS and drugs programmes is needed to create policies for supportive environments to bring about changes in both drug use and HIV risk behaviours.

Rising HIV infection rates in Ho Chi Minh City herald emerging AIDS epidemic in Vietnam

OBJECTIVE

To describe the epidemiology of HIV in Ho Chi Minh City in the context of current surveillance data from Vietnam.

METHODS

Since the late 1980s, HIV surveillance data have been collected in Ho Chi Minh City from centers for the treatment of venereal disease and tuberculosis, centers for the rehabilitation of injecting drug users and sex workers, prenatal clinics, blood banks and other sites.

RESULTS

The first case of HIV infection in Vietnam was identified in 1990 in Ho Chi Minh City. The cumulative number of reported HIV infections in this city at the end of 1996 was 2774, about half of the number of cases in the country; 86% of infections were among men, 86% among injecting drug users, 2.5% among patients with sexually transmitted diseases and 2.5% among sex workers. The first HIV infection among antenatal women was detected in 1994. The prevalence of HIV among injecting drug users rose dramatically from 1% in 1992 to 39% in 1996, compared with 1.2% among sex workers, 0.3% among blood donors and 1.3% among tuberculosis patients in 1996. The populations of injecting drug users and sex workers in Ho Chi Minh City are estimated to be 30000 and 80000, respectively, and rates of sexually transmitted diseases are 2-3 per 1000 persons per year. By the end of December 1996, 42 out of 53 provinces had reported HIV infections, and border areas near China and Cambodia began identifying large numbers of HIV-seropositive people.

CONCLUSIONS

Ho Chi Minh City is at the forefront of a new HIV epidemic in Vietnam. This epidemic shows similarities to that in Thailand nearly a decade ago, with rapidly rising HIV rates among injecting drug users and infection already established among sex workers. Prevention efforts should include the targeting of injecting drug users and sex workers outside rehabilitation centers, the availability of sterile needles and condoms, the establishment of anonymous testing sites, the control of sexually transmitted diseases and the coordination of programs within southeast Asia.