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Does poverty lead to non-fatal unintentional injuries in rural Vietnam?
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.ORCID iD: 0000-0001-5474-4361
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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.

Place, publisher, year, edition, pages
2005. Vol. 12, no 1, 31-37 p.
Keyword [en]
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: urn:nbn:se:umu:diva-13885DOI: 10.1080/17457300512331342207PubMedID: 15814373OAI: oai:DiVA.org:umu-13885DiVA: diva2:153556
Available from: 2007-05-16 Created: 2007-05-16 Last updated: 2015-04-29Bibliographically approved
In thesis
1. Epidemiology of unintentional injuries in rural Vietnam
Open this publication in new window or tab >>Epidemiology of unintentional injuries in rural Vietnam
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
Public health, unintentional injury, community-based, surveillance, Vietnam, Folkhälsomedicin
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-322 (URN)91-7305-723-1 (ISBN)
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
2. The injury poverty trap in rural Vietnam: causes, consequences and possible solutions
Open this publication in new window or tab >>The injury poverty trap in rural Vietnam: causes, consequences and possible solutions
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The focus of this study is the vicious circle of poverty and ill-health. The case is injuries but it could have been any lasting and severe disease. Poverty and health have very close links to economic development and to how health care is financed. Out-of-pocket payment seems to increase the risk of poverty while prepaid health care reduces it. The overall objective is to investigate the “injury poverty trap” and suggest possible solutions for it. A cohort of 23,807 people living in 5,801 households in Bavi district of Vietnam was followed from 1999 to 2003 to investigate income losses caused by non-fatal unintentional injuries in 2000 as well as the relationships between social position in 1999 and those injuries. For the possible solutions, a survey in 2064 household was performed to elicit people’s preferences and willingness to pay for different health care financing options. The results showed that unintentional injuries imposed a large economic burden on society, especially on the victims. By two pathways – treatment costs and income losses – unintentional injury increased the risk of being poor. The losses for non-poor and poor injured households were about 15 and 11 months of income of an average person in the non-poor and poor group, respectively. Furthermore, poverty was shown to be a probable cause of non-fatal unintentional injuries. Specifically, poverty led to home injuries among children and the elderly, and adults 15 – 49 years of age were particularly at risk in the workplace. The middle-income group was at greatest risk for traffic injuries, probably due to the unsafe use of bicycles or motorbikes. About half of the population preferred to keep an out-of-pocket system and the other half preferred health insurance. People’s willingness to pay suggested that a community-based health insurance scheme would be feasible. However, improvements in the existing health insurance systems are imperative to attract people to participate in these or any alternative health insurance schemes, since the limitations of the existing systems were generalized to health insurance as a whole. A successful solution should follow two tracks: prepayment of health care and some insurance based compensation of income losses during the illness period. If the risk of catastrophic illness is more evenly spread across the society, it would increase the general welfare even if no more resources are provided.

Place, publisher, year, edition, pages
Umeå: Folkhälsa och klinisk medicin, 2005. 182 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 990
Keyword
unintentional injury, poverty, out-of-pocket payment, health insurance, Vietnam
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-627 (URN)91-7305-958-7 (ISBN)
Public defence
2005-12-09, 09:00 (English)
Supervisors
Available from: 2005-11-16 Created: 2005-11-16 Last updated: 2010-01-29Bibliographically approved

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Byass, PeterLindholm, Lars

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