Trang Thu Nguyen

Prevalence and risk factors for symptoms of common mental disorders in early and late pregnancy in Vietnamese women: A prospective population-based study.

BACKGROUND Little is known about the prevalence of and risk factors for common mental disorders (CMD) in pregnant women in low-income countries. The aim of this study was to establish the prevalence of and psychosocial risk factors for clinically significant symptoms of CMD in early and late pregnancy in women in rural Viet Nam. METHODS A population-based sample of women was surveyed in early and late pregnancy. CMD were assessed by the Edinburgh Postnatal Depression Scale-Viet Nam Validation and psychosocial risks by study-specific structured interviews. RESULTS In total 497/523 (97%) eligible women were recruited and 419 (84%) provided complete data. Prevalence of CMD only in early pregnancy was 22.4% (95% CI 18.4-26.4); only in late pregnancy was 10.7% (95% CI 7.8-13.7) and at both assessment waves was 17.4% (95% CI 13.8-21.1). Non-economic and economic coincidental life adversity, intimate partner violence, past pregnancy loss, and childhood abuse were positively associated with persistent antenatal CMD. Older age, having a preference for the babys sex, and nulli- or primiparity were risk factors for CMD in early pregnancy. CONCLUSIONS Persistent antenatal CMD are prevalent in rural areas of Viet Nam. Psychosocial risk factors play a major role in this significant public health problem.

Intimate partner violence and perinatal common mental disorders among women in rural Vietnam

INTRODUCTION Intimate partner violence against women (IPV) is regarded increasingly as a public health problem worldwide. The overall aim of this study was to examine the associations between different exposures to IPV and womens mental health during pregnancy and after childbirth in rural Vietnam. METHODS This was a secondary analysis of data generated in a community-based longitudinal investigation in which a cohort of pregnant women were recruited and followed until 6 months after childbirth. Different forms of IPV were measured by the Intimate Partner Violence section of the WHO Multi-Country Study on Womens Health and Domestic Violence Against Women questionnaire. The Edinburgh Postnatal Depression Scale-Vietnam Validation was used to assess symptoms of the common perinatal mental disorders of depression and anxiety (CPMD). RESULTS Overall, 497 women were recruited and complete data were available from 417 (83.9%). Exposure to either lifetime or perinatal IPV including emotional abuse, physical violence and sexual violence was associated with increased CPMD symptoms (adjusted odds ratio, OR, ranges 1.3-14.3) and suicidal thoughts (OR ranges 4.7-6.1) in women during pregnancy and after childbirth. Experiencing more than one form of IPV increased the magnitude of the association between IPV and CPMD symptoms and thoughts of suicide. CONCLUSION It is clearly essential in this and other resource-constrained settings to address emotional, physical and sexual violence perpetrated by an intimate partner in any strategies to reduce the risk of perinatal mental health problems in women.

Infant motor development in rural Vietnam and intrauterine exposures to anaemia, iron deficiency and common mental disorders: a prospective community-based study

BackgroundAntenatal anaemia, iron deficiency and common mental disorders (CMD) are prevalent in low- and middle-income countries. The aim of this study was to examine the direct and indirect effects of antenatal exposures to these risks and infant motor development.MethodsA cohort of women who were pregnant with a single foetus and between 12 and 20 weeks pregnant in 50 randomly-selected rural communes in Ha Nam province was recruited. Participants provided data twice during pregnancy (early and late gestation) and twice after giving birth (8 weeks and 6 months postpartum). The Edinburgh Postnatal Depression Scale was used at all four data collection waves to detect CMD (score ≥ 4). Maternal anaemia (Hb < 11 g/dL) and iron deficiency (ferritin < 15 ng/mL) were evaluated at early and late gestation. Infants’ motor development was assessed by the Bayley of Infant and Toddler Development Motor Scales (BSID-M) at the age of six months. Direct and indirect effects of the exposures on the outcome were examined with Path analysis.ResultsIn total, 497 of 523 (97%) eligible pregnant women were recruited and 418 mother-infant pairs provided complete data and were included in the analyses. The prevalence of anaemia was 21.5% in early pregnancy and 24.4% in late pregnancy. There was 4.1% iron deficiency at early pregnancy and 48.2% at late pregnancy. Clinically significant symptoms of CMD were apparent among 40% women in early pregnancy and 28% in late pregnancy. There were direct adverse effects on infant BSID-M scores at 6 months of age due to antenatal anaemia in late pregnancy (an estimated mean reduction of 2.61 points, 95% Confidence Interval, CI, 0.57 to 4.65) and CMD in early pregnancy (7.13 points, 95% CI 3.13 to 11.13). Iron deficiency and anaemia in early pregnancy were indirectly related to the outcome via anaemia during late pregnancy.ConclusionsAntenatal anaemia, iron deficiency, and CMD have a negative impact on subsequent infant motor development. These findings highlight the need to improve the quality of antenatal care when developing interventions for pregnant women that aim to optimise early childhood development in low- and middle-income countries.

Common perinatal mental disorders and alcohol dependence in men in northern Viet Nam

BACKGROUND To establish the prevalence and correlates of the perinatal common mental disorders of depression and anxiety (PCMD) and alcohol dependence (AD) in men in northern Viet Nam. METHODS A cross-sectional study of men whose wives were >28weeks pregnant or mothers of newborns recruited from randomly-selected rural and urban communes. Data sources were Structured Clinical Interviews for DSM IV; CAGE assessment of alcohol use and study-specific questionnaires. Odds ratios and 95% CIs were calculated by multiple logistic regressions. RESULTS Overall, 231/360 eligible men were recruited, of whom 17.7% [95% CI, 12.8-22.7] were diagnosed with a PCMD; 33.8% [95% CI, 27.9-40.1] with AD (CAGE score≥2) and 6.9% [95% CI, 4.3-11.0] with co-morbid PCMD and AD. PCMD were associated with experiences of coincidental life adversity, intimate partner violence, age>30; an unwelcome pregnancy and primiparity. AD was more common among men with low education, living in the poorest households and in unskilled work. CONCLUSIONS Common mental disorders and AD are prevalent, but currently unrecognised among men in northern Viet Nam whose wives are pregnant or have recently given birth.

Effects of tidal forcing, conductivity gradient, and active seeding on the climatology of equatorial spread F over Kwajalein

Plasma structure in nighttime equatorial F layer, referred to as equatorial spread F (ESF), displays climatology whose seasonal variation depends on longitude. At longitudes where ESF favors equinoxes, times when maxima occur can be predicted in terms of the day of year, when E region sunset is simultaneous in conjugate hemispheres (i.e., “sunset nodes”). Aside from occurrences around equinoxes, there are only three longitudes where ESF also occurs during a solstice; one is the central Pacific region. Here ESF activity is strong during the June solstice, when solar activity is high. To understand this puzzling behavior, ESF climatology over the Kwajalein Atoll was compared with properties of the postsunset rise (PSSR) of the F layer and seeding activity in the troposphere. The key findings are as follows: (1) Maxima in PSSR velocity (VPSSR) are better aligned with equinoxes than with sunset nodes; hence, seasonal pattern of VPSSR, not only sunset nodes, should be included in interpretation of ESF climatology. (2) The source of VPSSR during solstice appears to differ from that during equinoxes. (3) Equinoctial maxima in VPSSR could be related to a semiannual variation in equatorial electrojet strength and its contribution to polarization of the F region dynamo current. (4) Enhanced VPSSR during the June solstice is interpreted in terms of tidal forcing with a wave number of 2. (5) Displacements of maxima in ESF climatology from maxima in VPSSR are shown to be consistent with deep convective activity.

Postpartum change in common mental disorders among rural Vietnamese women: incidence, recovery and risk and protective factors

BACKGROUND In low- and middle-income countries little is known about changes in womens mental health status from the perinatal period to 15 months postpartum or the factors associated with different trajectories. AIMS To determine the incidence and rates of recovery from common mental disorders (CMD) among rural Vietnamese women and the risk and protective factors associated with these outcomes from the perinatal period to 15 months after giving birth. METHOD In a population-based prospective study, a systematically recruited cohort of women completed baseline assessments in either the last trimester of pregnancy or 4-6 weeks after giving birth and were followed up 15 months later. The common mental disorders of major depression, generalised anxiety and panic disorder were assessed by psychiatrist-administered Structured Clinical Interview for DSM-IV Disorders at both baseline and follow-up. RESULTS A total of 211 women provided complete data in this study. The incidence rate of CMD in the first postpartum year was 13% (95% CI 8-19), and 70% (95% CI 59-80) of women who had perinatal CMD recovered within the first postpartum year. Incidence was associated with having experienced childhood maltreatment, experiencing the intimate partner as providing little care, sensitivity, kindness or affection, and the chronic stress of household poverty. Recovery was associated with higher quality of a womans relationships with her intimate partner and her own mother, longer period of mandated rest following birth, and sharing of domestic tasks and infant care. CONCLUSIONS Modifiable social factors, in particular the quality of a womans closest relationships with her partner and her own mother, and participation by family members in domestic work and infant care, are closely related to womens mental health in the first year after giving birth in resource-constrained settings.

Off-great-circle paths in transequatorial propagation: 1. Discrete and diffuse types

There is mounting evidence that plasma structure in nighttime equatorial F layer evolves from large-scale wave structure (LSWS) in the bottomside F layer. This process cannot be ignored because equatorial plasma bubbles (EPBs), arise from large-amplitude LSWS; and, because intense radiowave scintillations are associated with EPBs, understanding the LSWS-to-EPB process is a crucial step toward reliable space-weather forecasting. In this regard, the transequatorial propagation (TEP) experiment appears to be most useful among available research instruments. After a lapse of 30 years, the TEP experiment has been resurrected [e.g., Maruyama and Kawamura, 2006]; a goal of this research is to understand TEP measurements well enough so that they can be used to diagnose the LSWS-to-EPB process. Toward this end, new results are presented in two companion papers. Herein (P1), off-great-circle (OGC) propagation paths are shown to consist of two types, discrete and diffuse. The new findings include: (1) a generalized multi-reflection model that can explain most of the observed properties; (2) the discrete type is supported by multi-reflections from an unstructured upwelling, (3) the diffuse type is supported by reflections from plasma structure in EPBs; and (4) the observed east-west (EW) asymmetry can be explained in terms of a distorted upwelling or plasma structure along the west wall of an upwelling. In Paper 2 (P2), a second form of observed EW asymmetry is explained in terms of plasma structure, which is not aligned with the geomagnetic field. The findings strongly confirm a close relationship between upwellings, ESF patches, and OGC paths.

Addressing multiple modifiable risks through structured community-based Learning Clubs to improve maternal and infant health and infant development in rural Vietnam: protocol for a parallel group cluster randomised controlled trial

Introduction Optimal early childhood development is an international priority. Risks during pregnancy and early childhood have lasting effects because growth is rapid. We will test whether a complex intervention addressing multiple modifiable risks: maternal nutrition, mental health, parenting capabilities, infant health and development and gender-based violence, is effective in reducing deficient cognitive development among children aged two in rural Vietnam. Methods and analysis The Learning Clubs intervention is a structured programme combining perinatal stage-specific information, learning activities and social support. It comprises 20 modules, in 19 accessible, facilitated groups for women at a community centre and one home visit. Evidence-informed content is from interventions to address each risk tested in randomised controlled trials in other resource-constrained settings. Content has been translated and culturally adapted for Vietnam and acceptability and feasibility established in pilot testing. We will conduct a two-arm parallel-group cluster-randomised controlled trial, with the commune as clustering unit. An independent statistician will select 84/112 communes in Ha Nam Province and randomly assign 42 to the control arm providing usual care and 42 to the intervention arm. In total, 1008 pregnant women (12 per commune) from 84 clusters are needed to detect a difference in the primary outcome (Bayley Scales of Infant and Toddler Development Cognitive Score <1 SD below standardised norm for 2 years of age) of 15% in the control and 8% in the intervention arms, with 80% power, significance 0.05 and intracluster correlation coefficient 0.03. Ethics and dissemination Monash University Human Research Ethics Committee (Certificate Number 20160683), Melbourne, Victoria, Australia and the Institutional Review Board of the Hanoi School of Public Health (Certificate Number 017-377IDD- YTCC), Hanoi, Vietnam have approved the trial. Results will be disseminated through a comprehensive multistranded dissemination strategy including peer-reviewed publications, national and international conference presentations, seminars and technical and lay language reports. Trial registration number ACTRN12617000442303; Pre-results.