Ha Nguyen

Impact of Measles Elimination Activities on Immunization Services and Health Systems: Findings From Six Countries

BACKGROUND One of the key concerns in determining the appropriateness of establishing a measles eradication goal is its potential impact on routine immunization services and the overall health system. The objective of this study was to evaluate the impact of accelerated measles elimination activities (AMEAs) on immunization services and health systems in 6 countries: Bangladesh, Brazil, Cameroon, Ethiopia, Tajikistan, and Vietnam. METHODS Primary data were collected from key informant interviews and staff profiling surveys. Secondary data were collected from policy documents, studies, and reports. Data analysis used qualitative approaches. RESULTS This study found that the impact of AMEAs varied, with positive and negative implications in specific immunization and health system functions. On balance, the impacts on immunization services were largely positive in Bangladesh, Brazil, Tajikistan, and Vietnam, while negative impacts were more significant in Cameroon and Ethiopia. CONCLUSIONS We conclude that while weaker health systems may not be able to benefit sufficiently from AMEAs, in more developed health systems, disruptions to health service delivery are unlikely to occur. Opportunities to strengthen the routine immunization service and health system should be actively sought to address system bottlenecks in order to incur benefits to eradication program itself as well as other health priorities.

Catastrophic household costs due to injury in Vietnam

OBJECTIVE Little is known about the costs of injury and their impact on injured persons and their families in Vietnam. This study aimed to examine the cost of injury in hospitalised patients and to identify the most costly injuries and those more likely to result in catastrophic household expenditure. METHOD A prospective cohort study was conducted, recruiting individuals admitted to Thai Binh General Hospital due to injury in Vietnam from January to August 2010. During the hospitalisation period, data on expenditure including direct medical, direct non-medical and indirect costs were collected. Demographic and injury characteristics were also obtained. The associations between the risk of catastrophic expenditure and injury cause, severity and principal injured region were examined by modified Poisson regression approach. Payment of more than 40% of the household non-subsistence spending was considered a catastrophic expenditure. RESULTS Of 918 patients approached, 892 (97%) were recruited. Total costs for all participants during the hospitalisation period were US

The economic burden of road traffic injuries: evidence from a provincial general hospital in Vietnam

325,812. Patients admitted for road injury accounted for the largest number of injuries (n=477, 53%), and the largest percentage of the total costs (US

Child injury prevention in Vietnam: Achievements and challenges

175,044, 57%). This was followed by individuals hospitalised due to falls, representing 29% of the sample (n=261) and 31% of the total costs (US

Economic Burden of Hospitalization Due to Injuries in North India: A Cohort Study.

103,128). In terms of cost per hospital stay, burn injuries were the most costly (US

Cost of surgery and catastrophic expenditure in people admitted to hospital for injuries: estimates from a cohort study in Vietnam.

427), followed by falls (US

Analysis of out-of-pocket costs associated with hospitalised injuries in Vietnam

395) and road crashes (US

Status of road safety and injury burden: Vietnam

367). Of all sample, 26% experienced catastrophic expenditure due to their injuries. Factors significantly associated with increased risk of catastrophic expenditure were having more severe or higher MAIS injuries (RR=2.02, 95% CI: 1.14-3.57), principal injured region to lower extremities (RR=3.34, 95% CI: 1.41-7.91) or head (RR=3.21, 95% CI: 1.37-7.52), longer hospital stay (RR=1.09, 95% CI: 1.07-1.10), older age, lower income and not having insurance (RR=1.63, 95% CI: 1.21-2.21). CONCLUSION A high proportion of households experienced catastrophic expenditure following injury, highlighting the important need for programmes to prevent injuries, road traffic and fall-related injuries in particular. Furthermore, expansion of health insurance coverage may help individuals cope with the financial consequences of injury.

Economic evaluation of Indigenous health worker management of poorly controlled type 2 diabetes in north Queensland

Objective To examine the costs of road traffic injuries (RTIs) in Vietnam and factors associated with increased costs. Method RTI data were collected in a prospective cohort study on the impact of injuries in Vietnam. Participants were persons admitted to the Thai Binh General Hospital because of RTI. All costs incurred by participants and their family members during hospitalisation were collected, including direct medical costs, direct non-medical costs and indirect costs. Generalised linear models were employed to examine predictors of increased costs including demographic and injury context characteristics. Results Each RTI hospitalisation costs the patient and family on average US

Cost and impoverishment 1 year after hospitalisation due to injuries: a cohort study in Thái Bình, Vietnam

363 or 6 months of average salary. Income, injury severity, principal region of injury and length of hospital stay were statistically significant predictors of increased costs; age, gender, occupation and road user group were not. After controlling for injury characteristics and income, participants with principal injuries to the lower extremities had a cost 1.28 (95% CI 1.07 to 1.54) times higher than those with principal injuries to the face. Analyses of motorcycle-related RTIs with principal injury to the head also showed increased costs among those without a helmet (1.41 times higher, 95% CI 1.17 to 1.71). Conclusions RTIs can cause a substantial economic burden to the patient and family. During hospitalisation on average, an RTI would cost approximately 6 months of salary. In addition to interventions to decrease the risk of RTIs, those reducing the severity, such as wearing a motorcycle helmet, should be enforced to minimise the economic and health consequences of injury.