Nguyen Minh Thang

Patterns of food consumption in Vietnam: effects on socioeconomic groups during an era of economic growth

Objective: To identify if the nutritional status and improvements in Vietnam during the 1990s applied equally to the key vulnerable population groups (poor, rural, and ethnic minority) as it did to the nonpoor—largely in the urban areas.Design: This study used cross-sectional analyses in the context of inequalities occurring in the diets of the poor and nonpoor that accompanied economic improvements during the Vietnam Doi Moi period.Setting: During the Doi Moi period in Vietnam.Subjects: A cross-sectional analysis was conducted on data using 23 839 individuals (4800 households) from the Vietnam Living Standard Survey (VLSS) in 1992–1993 and 28 509 individuals (6002 households) from the Vietnam Living Standard Survey in 1997–1998. Analysis for changes in food consumption was conducted on 17 763 individuals (4305 households) that were included in both surveys.Interventions: None.Results: After initiation of Doi Moi in 1986, the average Vietnamese person reached the dietary adequacy of 2100 kcal per day per capita in the early 1990s, but this did not improve during the next decade. The structure of diet shifted to less starchy staples while proteins and lipids (meat, fish, other protein-rich higher fat foods) increased significantly. Although the gap in nutrient intake between the poor and the nonpoor decreased, the proportion of calories from protein- and lipid-rich food for the poor is lower than for the nonpoor. The VLSS data showed that the increase of protein and lipid foods in total energy structure over the 5 y between the VLSS studies for poor households was 0.43% (CI=0.33, 0.53) and 0.47% (CI=0.41, 0.54) lower, respectively, than for nonpoor households (P<0.0001). Inequalities compared to the nonpoor were also found in both quantity and quality of food consumption. For example, poor households consumed (quantity) 127 kcal/day (CI=119, 135) less from meat, and 32 kcal/day (CI=27, 38) less from fats than nonpoor households (P<0.0001), and the proportion of calories consumed (quality) by poor households was 5.8% (CI=5.4, 6.1) less from meat and 0.96% (CI=1.2, 0.7) less from fats than by nonpoor households (P<0.0001).Conclusions: Although the key vulnerable groups—rural, poor, and minority populations—showed improvements in diet, there still remains an inequity between these groups and the nonpoor of the population. In particular, the vulnerable groups consumed less of their daily consumption from the desirable high-quality proteins of animal foods and fats, and more from cereals and other starches—lagging the better-off populations in desired composition.Sponsorship: Carolina Population Center, University of North Carolina at Chapel Hill, NC, USA.

CHILD IMMUNIZATION IN VIETNAM: SITUATION AND BARRIERS TO COVERAGE

This paper addresses the overall performance and inequalities in the immunization of children in Vietnam. Descriptive and logistic analysis of cross-national demographic and health data was used to examine inequality in immunization, identify the most vulnerable groups in immunization coverage, and identify the gap in coverage between hard-to-access people and the remainder of the population. The gap in the coverage was found to occur primarily in vulnerable groups such as the poor minority or poor rural children. No evidence was found of a difference in immunization coverage because of sex or birth order. However, the age of children showed a significant influence on the rate of immunization. Mothers education and regular watching of television had a significant influence on child immunization. In order to improve child immunization coverage in Vietnam, efforts should be concentrated on poor children from minority groups and those living in rural areas, especially remote ones. Community development, investment for immunization and re-organization of immunization services at the grassroots level are also key factors to remove the barriers to immunization for vulnerable populations in Vietnam.

Factors influencing infant mortality in Vietnam.

Selected determinants of overall infant mortality in Vietnam were examined using data from the 1988 Vietnam Demographic and Health Survey, and factors underlying neonatal and post-neonatal mortality were also compared. Effects of community development characteristics, including health care, were studied by logistic regression analysis in a subsample of rural children from the 1990 Vietnam Accessibility of Contraceptives Survey. Infant neonatal and post-neonatal mortality rates showed comparable distributions by birth order, maternal age, pregnancy intervals, mothers education and urban-rural residence. Rates were highest among first order births, births after an interval of less than 12 months, births to illiterate mothers and to those aged under 21 or over 35 years of age. Logistic regression analysis showed that the most significant predictor of infant mortality was residence in a province where overall infant mortality was over 40 per 1000 live births. In the rural subsample, availability of public transport was the most persistent community development predictor of infant mortality. Reasons for the low infant mortality rates in Vietnam compared to countries with similar levels of economic development are discussed.

Changes in contraceptive use in Vietnam

This analysis used data, primarily from the 1997 Vietnamese Demographic and Health Survey (VN-DHS 1997), to determine the changes in contraceptive use in Vietnam. A descriptive analysis of individual, household and community characteristics was made to obtain a general description of contraceptive use. Multinomial logistic regression analyses were also performed on the currently married in (a) a sample of all women and (b) only those women who live in rural areas, to identify the strength of association that each variable has with the use of modern contraceptives. The use of any contraceptive method and the use of modern methods increased from 1988 to 1997. The primary contraceptive method utilized is the IUD and its use has increased substantially from 1988 to 1997. Younger women (aged 15-24) were less likely to use any contraceptive method. Women not desiring additional children were significantly more likely to use contraceptive methods than those desiring more children. Education has a clear impact on both contraceptive knowledge and use by women, with higher educated women being more likely to use a contraceptive method. Illiterate women with no formal education were significantly less likely to use modern methods of contraception. Differentials in contraceptive use exist regarding place of residence. Urban women are more likely than rural women to use contraception, but the difference is not large. Women living in mountainous areas are less likely to use contraception, compared with women living in the lowlands. Living standards, especially the availability of electricity in the community, have a large effect on the methods of contraception adopted by women. Religion is not strongly related to the contraceptive behaviour of women. There were significant differences in the use of contraceptives in communities with good quality of care, with increased contraceptive use corresponding to the increase in availability of family planning workers at communes, provision of counselling services at health facilities, and the volume of mass media family planning messages.

Selected determinants of fertility in Vietnam: age at marriage, marriage to first birth interval and age at first birth

Data from the 4172 women aged 15-49 interviewed in the 1988 Vietnamese Demographic and Health Survey were used to examine age at marriage, marriage to first birth intervals and age at first birth. Differences between urban and rural areas, northern and southern provinces and by education of the women were analysed. The majority of the women had their first birth before age 20, but women with secondary education had a significantly higher age at first birth than those with little or no education, and women from the north had a significantly higher age at first birth than women from the south. Rural women and those with little or no education married at significantly younger ages than urban women and those with secondary education; these education effects were confirmed in a rural subsample of women. Women from rural areas and from the north had significantly shorter marriage to first birth intervals than urban women and those from the south, but there were no significant effects related to education.

Variations in Vietnamese marriages, births and infant deaths by months of the Julian calendar and years of the Vietnamese and Chinese astrological calendars

The timing of births and marriages in Vietnam appears to have some statistically significant relationships with the signs of the Chinese and Vietnamese astrological calendars. Years considered to be good years have significantly more births and marriages than years that are not considered as desirable. Births and marriages also have some significant variations with seasons of the year. Infant deaths do not appear to have any significant relationships with the astrological signs although infant mortality has some significant relationships with seasons of the year. The findings indicate that there is some purposeful planning for marriages and births to coincide with optimal times defined in the astrological calendars.