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Epidemiology of unintentional injuries in rural Vietnam
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The main objective of this epidemiological study was to assess the incidence of unintentional non-fatal injuries, together with their determinants and consequences, in a defined Vietnamese population, thus providing a basis for future prevention. A one-year follow-up survey involved four quarterly cross-sectional household injury interviews during 2000. This cohort study was based within a demographic surveillance site in Bavi district, northern Vietnam, which provides detailed, longitudinal information in a continuous and systematic way. Findings relate to three phases of the injury process: before, during and after injury.

The study showed that unintentional non-fatal injuries were an important health problem in rural Vietnam. The high incidence rate of 89/1000 pyar reflected almost one tenth of the population being injured every year. Home injuries were found to be most common, often due to a lack of proper kitchens and dangerous surroundings in the home. Road traffic injuries were less common but tended to be more severe, with longer periods of disability and higher unit costs compared with other types of injury. The leading mechanisms of injury were impacts with other objects, falls, cuts and crushing. Males had higher injury incidence rates than females except among the elderly. Elderly females were often injured due to falls in the home. Being male or elderly were significant risk factors for injury. Poverty was a risk factor for injuries in general and specifically for home and work related injuries, but not for road traffic injuries. The middle income group was at higher risk of traffic injuries, possibly due to their greater mobility.

Injuries not only affected people’s health, but were also a great financial burden. The cost of an injury, on average, corresponded to approximately 1.3 months of earned income, increasing to 7 months for a severe injury. Ninety percent of the economic burden of injury fell on households, only 8% on government and 2% on health insurance agencies. Self-treatment was the most common way of treating injuries (51.7%), even in some cases of severe injury. There was a low rate of use of public health services (23.2%) among injury patients, similar to private healthcare (22.4%). High cost, long distances, residence in mountains, being female and coming from ethnic minorities were barriers for seeking health services. People with health insurance sought care more, but the coverage of health insurance was very low.

Some prevention strategies might include education and raising awareness about the possible dangers of injury and the importance of seeking appropriate care following injury. To avoid household hazards, several strategies could be used: better light in the evening, making gravel paths around the house, clearing moss to avoid slipping, wearing protective clothing when using electrical equipment and improving kitchens. Similarly, improving road surfaces, having separate paths for pedestrians and cyclists and better driver training could reduce road accidents.

In Vietnam, and especially in a rural district without any injury register system, a community-based survey of unintentional injuries has been shown to be a feasible approach to injury assessment. It gave more complete results than could have been obtained from facility-based studies and led to the definition of possible prevention strategies.

Place, publisher, year, edition, pages
Umeå: Folkhälsa och klinisk medicin , 2004. , 67 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 914
Keyword [en]
Public health, unintentional injury, community-based, surveillance, Vietnam
Keyword [sv]
Folkhälsomedicin
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-322ISBN: 91-7305-723-1 (print)OAI: oai:DiVA.org:umu-322DiVA: diva2:143101
Public defence
2004-10-15, 135, 9A, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2004-09-24 Created: 2004-09-24 Last updated: 2010-05-07Bibliographically approved
List of papers
1. Community-based assessment of unintentional injuries: a pilot study in rural Vietnam
Open this publication in new window or tab >>Community-based assessment of unintentional injuries: a pilot study in rural Vietnam
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2003 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 31, no Supplement 62, 38-44 p.Article in journal (Refereed) Published
Abstract [en]

AIMS: Although unintentional injuries are recognised as a major public health problem globally, little is known about their patterns and rates at the community level in most low-income countries. Rapid social development, leading to increased traffic and industrialization, may be changing patterns of injury. Injuries within the home environment have not so far been recognized to the same extent as traffic and work-related injuries in Vietnam, largely because they have not been effectively counted. This study took place in northern Vietnam, in the context of a longitudinal community surveillance site called FilaBavi, as a pilot project aiming to determine the community incidence of unintentional injury and to explore appropriate methods for community-based injury surveillance. METHODS: An initial study population of 23,807 was identified and asked about their experience of injury in the preceding three months. RESULTS: Overall 450 new injuries were detected over 5,952 person-years, a rate of 76 per 1,000 person-years. Males were injured at 1.6 times the rate of females, and home and road traffic accidents were most common. Most injuries occurred during unpaid household tasks. Cutting and crushing injuries occurred most frequently. Of 221 deaths from all causes in the FilaBavi population during 1999 among 43,444 person-years, 25 were attributed to unintentional injuries and two to suicide. Unintentional injury was the third leading cause of death in this community, with a case-fatality rate of 0.8%. DISCUSSION: The findings suggest that greater attention needs to be directed toward the prevention of injuries occurring in the home in rural Vietnam. On the basis of this pilot study, a one-year study using the same approach is under way to characterize the patterns of unintentional injury in more detail, including any seasonal variation.

Keyword
community-based, surveillance, unintentional injury, Vietnam
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-4121 (URN)10.1080/14034950310015095 (DOI)14578075 (PubMedID)
Available from: 2004-09-24 Created: 2004-09-24 Last updated: 2017-12-14Bibliographically approved
2. Unintentional injuries over a 1-year period in a rural Vietnamese community: describing an iceberg.
Open this publication in new window or tab >>Unintentional injuries over a 1-year period in a rural Vietnamese community: describing an iceberg.
2005 (English)In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 119, no 6, 466-473 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To document unintentional injuries in a rural community over a 1-year period as a basis for prioritizing preventive activities. STUDY DESIGN: Quarterly home visits over 1 year to elicit experience of injury among household members in the preceding 3 months. METHODS: In total, 24,776 people living in rural communities in the Bavi District, Northern Vietnam, were surveyed in home visits during 2000. In the home visits, injuries that needed care or disrupted normal activities were recorded, together with their circumstances. RESULTS: Overall, 2079 new non-fatal injuries were recorded over 23,338 person-years, a rate of 89/1000 person-years-at-risk. Males had a significantly higher injury rate than females for all age groups except for those aged 35-59 years and the elderly (P<0.05). The elderly were at highest risk of injury (P<0.05), particularly females. Home injuries occurred at the highest overall rate, particularly among the elderly. Road traffic injuries were most common among children. Most injuries involved contact with another object. Less than one-quarter of injury victims sought care at a health facility. CONCLUSIONS: Community-based household surveys revealed the hidden part of the injury iceberg, as well as showing high incidence rates, indicating that injury is an important public health problem which should be a priority for intervention in rural Vietnam, and probably elsewhere. This comprehensive study is intended to contribute evidence and methods to the Ministry of Health's national programme for injury prevention, and to a wider audience.

Keyword
Injury, Surveillance, Vietnam, Community, Traffic, Accidents
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-30555 (URN)10.1016/j.puhe.2004.08.022 (DOI)15826887 (PubMedID)
Available from: 2010-01-08 Created: 2010-01-08 Last updated: 2017-12-12Bibliographically approved
3. Incidence and seasonal variation of injury in rural Vietnam: a community-based survey
Open this publication in new window or tab >>Incidence and seasonal variation of injury in rural Vietnam: a community-based survey
2004 (English)In: Safety Science, ISSN 0925-7535, E-ISSN 1879-1042, Vol. 42, no 8, 691-701 p.Article in journal (Refereed) Published
Abstract [en]

Study objective: To describe seasonal effects on injury incidence at the community level and to assess the relative merits of cross-sectional or longitudinal surveillance for injuries in such a setting.

Population and methods: This study took place in Bavi district, northern Vietnam, in the context of a longitudinal community surveillance site called FilaBavi. All non-fatal unintentional injuries which occurred in a sample of 24,776 people living in 5801 households were recorded during 2000. Four interview surveys per household were conducted continuously during 2000, each covering a 3-month period of recall. Injury morbidity data were analysed according to gender, age and circumstances of injury. Statistical analyses were based on monthly, quarterly and annual incidence rates with 95% confidence intervals. Significant differences between incidence rates were noted where the 95% confidence interval of the rate ratio excluded unity.

Results: There were 1917 persons who experienced a total of 2079 new non-fatal injuries during the period of observation, corresponding to an incidence of 89/1000 person-years. Seasonal variations were found in all types of injury. Overall, the highest incidence rates were observed in July and April, while the lowest monthly rates were found in May and November. Peaks were observed in February and April for traffic injuries, June for work-related injuries, July, August and October for home injuries. A significantly higher incidence rate was found in the third quarter survey (103/1000 person-years, p<0.05).

Conclusion: There can be interesting and significant seasonal variations in injury incidence within a community such as seen here in rural Vietnam and these variations have important implications for the design and planning of injury surveillance activities. Seasonal effects may cause invalid assessments of an injury problem if only cross-sectional household surveys are used, demonstrating the need for longitudinal approaches to injury incidence surveillance.

Keyword
Injury, Accidents, Seasonal variation, Surveillance, Community-based survey, Vietnam
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-13613 (URN)10.1016/j.ssci.2003.12.001 (DOI)
Available from: 2007-05-11 Created: 2007-05-11 Last updated: 2017-12-14Bibliographically approved
4. Does poverty lead to non-fatal unintentional injuries in rural Vietnam?
Open this publication in new window or tab >>Does poverty lead to non-fatal unintentional injuries in rural Vietnam?
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2005 (English)In: International Journal of Injury Control and Safety Promotion, ISSN 1745-7300, Vol. 12, no 1, 31-37 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to identify associations between poverty at the household level and unintentional injury morbidity. A cohort consisting of 24,874 person-time episodes, representing 24,776 people living in 5,801 households (classified into rich, middle income and poor by local authorities in 1999) was followed during 2000, in order to identify and assess non-fatal unintentional injuries. Incidence rate ratios were calculated using a Poisson regression model. The results showed that poverty was a risk factor for unintentional injuries generally. When looking at different types of injury, poverty was a risk for home, work and "other" injuries, protective for school injuries, while the risk of traffic injuries was not affected. The results also showed that communes in mountainous areas were at higher risk for home, work and other injuries. Overall, poverty was associated with unintentional injury morbidity. However, the relationship varied by sex, age and type of injury. Specifically, poverty increased the risk for children and elderly people being injured at home, and for adults (15-59 years) being affected by work injuries.

Keyword
Adolescent, Adult, Age Distribution, Aged, Child, Cluster Analysis, Cohort Studies, Developing Countries, Female, Humans, Incidence, Male, Middle Aged, Poisson Distribution, Poverty, Risk Factors, Rural Health, Sex Distribution, Vietnam/epidemiology, Wounds and Injuries/epidemiology/*etiology
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-13885 (URN)10.1080/17457300512331342207 (DOI)15814373 (PubMedID)
Available from: 2007-05-16 Created: 2007-05-16 Last updated: 2015-04-29Bibliographically approved
5. The economic burden of unintentional injuries: a community-based cost analysis in Bavi, Vietnam.
Open this publication in new window or tab >>The economic burden of unintentional injuries: a community-based cost analysis in Bavi, Vietnam.
2003 (English)In: Scandinavian journal of public health. Supplement, ISSN 1403-4956, Vol. 62, 45-51 p.Article in journal (Refereed) Published
Abstract [en]

AIMS: Relatively little is known about patterns of injury at the community level in Vietnam and their economic consequences. This study sought to estimate the costs of various unintentional injuries in Bavi District during one year; to describe how costs depended on gender, age, circumstances, and severity of injury; and to describe how the economic burden of unintentional injuries was distributed between households, government, and health insurance agency. METHODS: A cohort study was undertaken, which involved four cross-sectional household surveys among sampled communities in the Bavi District during the year 2000, each asking about injuries in the preceding three months. The costing system in public healthcare in Vietnam was applied as well as information from the victims. RESULTS: The total cost of injuries over one year in Bavi District was estimated to be D3,412,539,000 (Vietnamese dong) (US$235,347), equivalent to the annual income of 1,800 people. In total, 90% of this economic burden fell on households, only 8% on government, and 2% on the health insurance agency. The cost of a severe injury to the corresponded to approximately seven months of earned income. Home and traffic injuries together accounted for more than 80% of the total cost, 45% and 38% respectively. The highest unit cost was related to traffic injuries, followed by home, "other", work-related, and school injuries in descending order. DISCUSSION: The results can be considered as an economic baseline that can be used in evaluations of future interventions aimed at preventing injuries.

Keyword
unintentional injury, poverty, out-of-pocket payment, health insurance, Vietnam
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-29872 (URN)10.1080/14034950310015103 (DOI)14649638 (PubMedID)
Available from: 2009-11-25 Created: 2009-11-25 Last updated: 2015-04-29Bibliographically approved
6. Difficulties in getting treatment for injuries in rural Vietnam
Open this publication in new window or tab >>Difficulties in getting treatment for injuries in rural Vietnam
2009 (English)In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 123, no 1, 58-65 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Knowledge about the health-seeking behaviour of injury patients is important for the improvement of community health services. The aims of this study were: (1) to describe the healthcare-seeking behaviour of injury patients; (2) to examine factors associated with injury patients seeking care at health facilities; and (3) to describe the costs of health care for injury patients. STUDY DESIGN: This study took place in Bavi District, northern Vietnam within a longitudinal community surveillance site (FilaBavi). All non-fatal unintentional injuries occurring in a sample of 24,776 people during 2000 were recorded. METHOD: The injury questionnaire included information on care-seeking behaviour, severity and consequences of injury. Both univariate and multivariate logistic regression models were used to find associations between sociodemographic factors and utilization of any health services, as well as for each type of health service used, compared with the group who did not use any health services. RESULT: Of 24,776 persons living in the study area, 1917 reported 2079 new non-fatal debilitating injuries during the four 3-month periods of observation. Health-seeking behaviour relating to the first 1917 injuries was analysed. Self-treatment was most common (51.7%), even in cases of severe injury. There was low usage of public health services (23.2%) among injury patients. Long distances, poor economic status and residence in difficult geographic areas such as highlands and mountains were barriers for seeking health services. A large proportion of household income was spent on treating injury patients. Poor people spent a greater proportion of their income on health care than the rich, and often used less qualified or untrained private providers. CONCLUSIONS: These results demonstrate the logistical and financial difficulties associated with the treatment of injuries in rural Vietnam. This suggests the need to make public health subsidies available more efficiently and equitably. Whilst this study looked at the situation specifically in the context of injury treatment, it is likely that similar patterns apply in other areas of health care.

Keyword
Injury, Vietnam, Healthcare seeking, Healthcare utilization, Healthcare insurance, Healthcare costs
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-21775 (URN)10.1016/j.puhe.2008.07.018 (DOI)19084880 (PubMedID)
Available from: 2009-04-20 Created: 2009-04-20 Last updated: 2017-12-13Bibliographically approved

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