Maternal & Child Health and Reproductive Health​

 

Maternal & Child Health and Reproductive Health covers the health concerns and interventions across the life course involving women before and during pregnancy; newborns, that is, the first 28 days of life; and children to their fifth birthday. This is the research topic of the ICHR Institute over the years with a team of domestic and international quality researchers. 

 

 

Prof. Vo Van Thang - director of ICHR, expert in research methodology, reproductive health, sexual health. Prof. Thang is a researcher who has contributed a lot of research in this field with international publications and multi-disciplinary and multinational collaborations. The picture on the right is a communication session on reproductive health for students by Prof. Thang.

 

Below are abstracts of the ICHR Institute's recent studies, with the names in bold being the members of the ICHR Institute.The full text can be found in the Institute's International publications directory.

 

1. Intergenerational effects of violence on women’s perinatal wellbeing and infant health outcomes: evidence from a birth cohort study in Central Vietnam

Huyen Phuc Do, Philip R. A. Baker, Thang Van Vo, Aja Murray, Linda Murray, Sara Valdebenito, Manuel Eisner, Bach Xuan Tran & Michael P. Dunne 

Background: Girls exposed to violence have a high risk of being victimized as adults and are more likely than nonabused women to have children who are treated violently. This intergenerational transmission may be especially serious when women suffer violence during pregnancy and early motherhood, as it impairs maternal wellbeing and infant health and development. This study examined the intergenerational effects of being exposed to childhood maltreatment (CM) and prenatal intimate partner violence (p-IPV) on perinatal mental distress and birth outcomes in central Vietnam.

Methods: A birth cohort study in Hue City, Vietnam was conducted with 150 women in the third trimester of pregnancy (Wave 1) and 3 months after childbirth (Wave 2). Using multivariable logistic regression models, augmented inverse-probability-weighted estimators and structural equation modelling (SEM), we analyzed a theoretical model by evaluating adjusted risk differences and pathways between CM, p-IPV and subsequent perinatal adversity and indicators of infant health problems.

Results: One in two pregnant women experienced at least one form of CM (55.03%) and one in ten pregnant women experienced both CM and p-IPV (10.67%). Mothers who experienced p-IPV or witnessed IPV as a child were approximately twice as likely to experience poor mental health during pregnancy [ARR 1.94, 95% CI (1.20–3.15)]. Infants had a two-fold higher risk of adverse birth outcomes (low birth weight, preterm birth, admission to neonatal intensive care) [ARR 2.45 95% CI (1.42, 4.25)] if their mothers experienced any form of p-IPV, with greater risk if their mothers were exposed to both CM and p-IPV [ARR 3.45 95% CI (1.40, 8.53)]. Notably, significant pathways to p-IPV were found via adverse childhood experience (ACE) events (β = 0.13), neighborhood disorder (β = 0.14) and partner support (β = − 1.3)

Conclusion: These results emphasize the detrimental and prolonged nature of the effect of violence during childhood and pregnancy. Exposure to childhood maltreatment and violence during pregnancy increases the risk of maternal mental health difficulties and adverse birth outcomes. Antenatal care systems need to be responsive to women’s previous experiences of violence and maternal mental health. The significant protective role of partner support and social support should also be considered when designing tailored interventions to address violence during pregnancy.

 

2. The impact of maternal adverse childhood experiences and prenatal depressive symptoms on foetal attachment: Preliminary evidence from expectant mothers across eight middle-income countries

Ruth Harriet Brown, Manuel Eisner, Susan Walker, Mark Tomlinson, Pasco Fearon, Michael P Dunne, Van Thang Vo, Asvini D.Fernando, Aja LMurraya

Background: Mothers from middle-income countries (MIC) are estimated to have higher rates of adverse childhood experiences (ACEs) and depression during pregnancy compared to mothers from high income countries. Prenatal depression can adversely impact on a mother's feelings towards her foetus and thus may be partially responsible for intergenerational transmission of risk associated with maternal ACEs. However, the extent to which prenatal depressive symptoms mediate the association between maternal ACEs and foetal attachment is unknown.

Methods: Data on foetal attachment, ACEs, and prenatal depression came from mothers in their third trimester of pregnancy (n = 1,185) located across eight MICs, participating in the prospective birth cohort Evidence for Better Lives Study – Foundational Research (EBLS-FR). Data were from the baseline measurement.

Results: Full-sample path mediation analyses, adjusting for relevant covariates, suggested a full mediating effect of prenatal depression. However, at the individual-country level, both positive and negative effects of ACEs on foetal attachment were observed after the inclusion of depressive symptoms as a mediator, suggesting cultural and geographical factors may influence a mother's empathic development after ACE exposure.

Conclusions: The findings reinforce the importance of screening for prenatal depression during antenatal care in MICs. Addressing prenatal depression within maternal health care may support foetal attachment and contribute to reducing the intergenerational transmission of disadvantage.

 

The Evidence for Better Lives Study (EBLS) is an innovative global birth-cohort study in eight cities across the world. In each city, the early childhood development of 1500 children within their family and community contexts will be tracked. ICHR Institute is pleased to represent Vietnam to participate in this multinational study. Please find more information about EBLS here.

 

3. Prenatal Attachment: Using Measurement Invariance to Test the Validity of Comparisons Across Eight Culturally Diverse Countries.

Sarah Foley, Claire Hughes, Aja Louise Murray, Adriana Baban, Asvini D. Fernando, Bernadette Madrid, Joseph Osafo, Siham Sikander, Fahad Abbasi, Susan Walker, Bao-Yen Luong-Thanh, Thang Van Vo, Mark Tomlinson, Pasco Fearon, Catherine L. Ward, Sara Valdebenito & Manuel Eisner 

Studies in high-income countries (HICs) have shown that variability in maternal-fetal attachment (MFA) predict important maternal health and child outcomes. However, the validity of MFA ratings in low- and middle-income countries (LMICs) remains unknown. Addressing this gap, we assessed measurement invariance to test the conceptual equivalence of the Prenatal Attachment Inventory (PAI: Muller, 1993) across eight LMICs. Our aim was to determine whether the PAI yields similar information from pregnant women across different cultural contexts. We administered the 18-item PAI to 1181 mothers in the third trimester (Mean age = 28.27 years old, SD = 5.81 years, range = 18–48 years) expecting their first infant (n = 359) or a later-born infant (n = 820) as part of a prospective birth cohort study involving eight middle-income countries: Ghana, Jamaica, Pakistan, Philippines, Romania, South Africa, Sri Lanka and Vietnam. We used Multiple Group Confirmatory Factor Analyses to assess across-site measurement invariance. A single latent factor with partial measurement invariance was found across all sites except Pakistan. Group comparisons showed that mean levels of MFA were lowest for expectant mothers in Vietnam and highest for expectant mothers in Sri Lanka. MFA was higher in first-time mothers than in mothers expecting a later-born child. The PAI yields similar information about MFA across culturally distinct middle-income countries. These findings strengthen confidence in the use of the tool across different settings; future studies should explore the use of the PAI as a screen for maternal behaviour that place children at risk.

 

4. Depression and its associated factors among pregnant women in central Vietnam

Bao-Yen Luong-Thanh,  Lan Hoang Nguyen, Linda Murray, Manuel Eisner, Sara Valdebenito, Tuyen Dinh Hoang,  Huyen Phuc Do,  Thang Van Vo

Abstract: To date, little attention has been given to prenatal depression, especially in low and middle-income countries. The aim of this research was to assess the prevalence of depression and its associated factors amongst pregnant women in a central Vietnamese city. This cross-sectional study included 150 pregnant women from 29 to 40weeks of gestation, from eight wards of Hue city, via quota sampling from February to May 2019. We employed the Patient Health Questionnaire (PHQ-9) to assess depression. Findings suggest the need to provide routine screening of pregnant women in primary care for depressive symptoms and other mental health problems. Keywords depression, mental Illness, pregnancy, wellbeing, women’s health.

 

5. Assistance for parents with unsettled infants in Central Vietnam: a qualitative investigation of health professionals’ perspectives

Linda Murray; Thach Tran; Vo Van Thang; Nicole McDonald; Sean Beggs; Jane Fisher

Background: Unsettled infant behaviours are a common concern for parents internationally, and have been associated with maternal stress, reduced parenting confidence, and postnatal mental health problems among parents. Little information currently exists regarding available support for the parents of unsettled infants in low-and-middle income countries such as Vietnam. We aimed to describe how unsettled infant behaviour was understood and investigated by Vietnamese health professionals, and what health education was provided to parents regarding infant sleep and settling.

Methods: This qualitative study elicited the perspectives of Vietnamese health professionals working in Thua Thien Hue Province, Vietnam. A semi-structured interview guide included participant demographics, and questions about providing assistance to the parents of unsettled infants, understandings of unsettled infant behaviour, management of unsettled infant behaviour and health education. Individual interviews or small-group discussions were undertaken in Vietnamese, data were translated and analysed in English. The authors used a thematic approach to analysis, supported by Nvivo software.

Results: Nine health professionals (four primary care doctors, one paediatrician and four nurses/midwives) working in urban and rural areas of Thua Thien Hue were interviewed. Four themes were created that reflected the responses to the literature-based interview questions. Health professionals described having received little formal training about infant sleep and settling, thus based their advice on personal experience. Information on infant sleep and settling was not included in health education for new mothers, which focused on breastfeeding and preventing malnutrition. Where advice was given, it was generally based on settling strategies involving high levels of caregiver intervention (holding, rocking, breastfeeding on demand and tolerating frequent overnight wakings) rather than behaviour management style strategies. Participants emphasised the importance of recognising and responding to infant behavioural cues (e.g infants cry when hungry).

Conclusions: There is an unmet need for information on infant sleep and settling for new parents and health professionals in Vietnam. Our findings suggest information for caregivers on how to respond sensitively to infant tired signs should be formally included in the training of health professionals in LALMI settings. Sleep and settling information should also be part of culturally appropriate multi-component maternal and child health interventions aimed at promoting early childhood development.

 

6. Mothers’ experiences of settling infants in central Vietnam “through their eyes”: A photo-elicitation study

Linda Murray; Nicole McDonald; Vo Van Thang

There is little research on beliefs and practices regarding unsettled infant behavior and infant sleep in low and lower-middle income countries such as Vietnam. Here, researchers used a participatory qualitative visual method (photo-elicitation) to investigate how infant settling was perceived “through the eyes” of new mothers in Central Vietnam. Four qualitative themes emerged from the data: “loneliness in the midst of the crowd”, “finding the right position”, “protecting from cold”, and “affection and exhaustion”. Further research into how parenting programs and evidence based infant sleep guidelines can be modified to be socially acceptable in Vietnam is recommended.

 

 

Linda Murray - PhD student from Queensland University of Technology (QUT), Australia that conducted project "Intervention model of health care for women with postnatal depression in central Vietnam" with technical support and advice from ICHR.

 

Prof. Michael Dunne - ICHR's director and Linda Murray taken a photo during Linda's data collection in Hue, Vietnam.

 

7. Maternal Healthcare Experiences of and Challenges for Women with Physical Disabilities in Low and Middle-Income Countries: A Review of Qualitative Evidence

Thi Vinh Nguyen; Julie King; Niki Edwards; Cong Tuan Pham; Michael Dunne

This article reports on the outcomes of a comprehensive review of qualitative research using the Joanna Briggs Institute (JBI) guidelines to guide a systematic approach addressing women with physical disabilities (WWPD)’s access to and utilization of maternal health care services in low and middle-income countries. The article specifically examines existing literature on the experiences and challenges facing WWPD in accessing and utilization of these services during pregnancy, childbirth and the post-natal period. Fifteen studies that met inclusion criteria were identified. Findings from the review highlight that pregnancy and motherhood are meaningful for WWPD in both individual and socio-cultural ways. Multiple challenges facing WWPD were identified, including low self-esteem and confidence, negative responses and lack of family support, problematic experiences of transport, health and other social systems for maternal healthcare of WWPD, and social unacceptance and discrimination from the community. Addressing barriers in accessing healthcare services was perceived as an individual responsibility of WWPD and their families, rather than perceptions that society had a responsibility to act. The reproductive rights of WWPD, particularly expression of sexuality and the right to motherhood needs to be conceptualized beyond individual responsibility. Society needs to eliminate attitudinal and environmental barriers to ensure WWPD can choose to be mothers without threat of discrimination or negative social consequences.

 

8. The Intergenerational Effects of Intimate Partner Violence in Pregnancy: Mediating Pathways and Implications for Prevention

Aja Louise Murray, Daniela Kaiser, Sara Valdebenito, Claire Hughes, Adriana Baban, Asvini D. Fernando, Bernadette Madrid, Catherine L. Ward, Joseph Osafo, Michael Dunne, Siham Sikander, Susan Walker, Vo Van Thang, Mark Tomlinson, Manuel Eisner

 

Prenatal intimate partner violence (P-IPV) can have significant adverse impacts on both mother and fetus. Existing P-IPV interventions focus on the safety of the mother and on reducing revictimization; yet expanding these to address the adverse impact on the fetus has considerable potential for preventing long-term negative developmental outcomes. In this review, we draw together evidence on major pathways linking exposure to P-IPV and child outcomes, arguing that these pathways represent potential targets to improve P-IPV intervention efforts. Using a narrative review of 112 articles, we discuss candidate pathways linking P-IPV to child outcomes, as well as their implications for intervention. Articles were identified via key word searches of social science and medical databases and by inspection of reference lists of the most relevant articles, including recent reviews and meta-analyses. Articles were included if they addressed issues relevant to understanding the effects of P-IPV on child outcomes via six core pathways: maternal stress and mental illness, maternal–fetal attachment, maternal substance use, maternal nutritional intake, maternal antenatal health-care utilization, and infection. We also included articles relevant for linking these pathways to P-IPV interventions. We conclude that developing comprehensive P-IPV interventions that target immediate risk to the mother as well as long-term child outcomes via the candidate mediating pathways identified have significant potential to help reduce the global burden of P-IPV.

 

9. Inter-partner violence during pregnancy, maternal mental health and birth outcomes in Vietnam: A systematic review

Huyen Phuc Do; Bach Xuan Tran; Cuong Tat Nguyen; Thang Van Vo; Philip R.A.Baker; Michael P.Dunne

Introduction: Intimate partner violence (IPV) is common worldwide and associated with maternal mental disorders and adverse child health outcomes. Research in this field in Vietnam is still nascent, although some substantial studies have emerged in recent years. The objective of this review was to estimate the prevalence of IPV during pregnancy in Vietnam and examine its impact upon women and children at an early age.

Methods: We searched seven bibliographic databases (from 1970 to 2018), browsed grey literature sources, and consulted experts. Two review authors independently extracted data and assessed risk of bias with using the Newcastle – Ottawa Quality Assessment Tool for non-randomized studies. A meta-analysis was conducted using the Mantel-Haenszel fixed-effect approach to estimate pooled effect (odds ratio) of Prenatal IPV (P-IPV) on maternal Common Mental Disorder (CMD).

Results: The selection process produced eight eligible studies of 4598 participants. Six studies were pooled. The estimated proportions of IPV during pregnancy ranged from 5.9% to 32.5% depending on the form of IPV. P-IPV is strongly associated with greater risk of both mental disorders and adverse birth outcomes (preterm labor and low-birth-weight). The meta-analysis revealed that women exposed to P-IPV have a 4-fold increased risk for prenatal CMD compared to non-abused peers (OR = 3.69, 95% CI (2.51–5.42), I2 = 36%). Women exposed to physical P-IPV had five-fold increased odds of premature labour, OR = 5.5, 95% CI (2.1–14.1) and almost six-fold increased odds of having low-birth-weight neonates, OR = 5.7, 95% CI (2.2–14.9).

Discussion: To improve mother and child well-being in Vietnam, multifaceted health policies should include routine screening for IPV and mental disorders in the antenatal care system. Taken together, the evidence supports calls for national programs in Vietnam to eliminate gender inequality and promote awareness of the serious harms caused by IPV.

 

10. Postpartum depressive symptoms and associated factors in married women: a cross-sectional study in Da Nang city, Vietnam

Thang Van Vo, Hoa Thi Kim Duong, Tuyen Dinh Hoang

Introduction: Postpartum depression (PPD) among women is a common mental health concern. It occurs at a time of major life change, coupled with the increased responsibilities associated with the care of a newborn infant. In Vietnam, the prevalence of depressive symptoms after giving birth has not been fully investigated. Research in the Northern provinces, in Ho Chi Minh City, and in Hue suggests postnatal depressive symptoms among women are common. This research aims to (1) estimate the prevalence of PPD symptoms among married women in one Vietnam city (Danang) and (2) identify the social and personal factors associated with postpartum depressive symptoms.

Methods: This cross-sectional study was conducted from July 2013 to August 2014 in 10 wards of Hai Chau District, Danang. A total of 600 mothers who gave birth 4 weeks to 6 months prior to being interviewed were recruited. Interviews were conducted using structured questionnaires, which included several dimensions: demographics, family living arrangements, expectations of pregnancy, expectations of infant gender, the woman’s relationship with her husband, exercise after birth, infant health, and anxiety about matters other than the birth. The Edinburgh Postpartum Depression Scale (EPDS) was used to examine PPD symptoms, with a cutoff point of 12/13.

Results: EPDS scores indicated the prevalence of PPD symptoms was 19.3% (95% CI: 16.16–22.50). Among women with PPD symptoms, 37.9% had suicidal thoughts in the previous seven days. Multivariate logistic regression indicated that the following key factors were significantly associated with PPD symptoms: Not being able to rely on their husband for help, having a husband who does not spend time to discuss problems, having anxiety about matters other than the birth, not exercising after giving birth, and having an ill baby.

Conclusion: These findings should be interpreted in relation to other recent research in Vietnam. A consistent pattern of prevalence estimates and associated social factors is emerging that has implications for the postpartum care of mothers.

 

11. Prevalence and associated factors of erectile dysfunction among married men in Vietnam

Thang Van Vo, Hue Dinh Hoang, Nhan Phuc Thanh Nguyen

Background: Sexuality is an essential part of life; however, erectile dysfunction (ED) has been one of the most common complaints among men with sexual health issues all over the world. ED includes dysfunction in erection and penile erectile pain. In Vietnam, ED is a subject a not readily discussed. Thus, relatively little is known about ED among Vietnamese men.

Aims: To identify the prevalence of ED and its associated variables and the need for treatment of ED among married men in Vietnam.

Methods: This was a cross-sectional study. A total sample size included 746 married men, aged 20–60 years, living in four representative wards of the Hue City and randomly selected by systematic sampling methods. Respondents completed a self-reported questionnaire. The International Index of Erectile Function (IIEF-5) scale was used to determine ED severity, and the Depression Anxiety Stress Scales (DASS-21) was used to measure depression, anxiety, and stress. Quality of life was assessed using the WHO Quality of Life score (WHOQoL). A multivariate logistic regression model was used to determine the relationships between independent variables and ED.

Results: Mean age of married men was 44.3 ± 8.7. Two-thirds (66.9%) of respondents experienced ED symptoms. In terms of severity, 40.8% reported mild ED; 20.3% mild–moderate ED; 5.0% moderate ED; and 0.8% severe ED. Depression, anxiety, and stress problems were 5.0, 3.6, and 2.8%, respectively. One-third (33.1%) of the respondents reported having low quality of life, and 32.6% reported having medium quality of life. The vast majority (86.9%) had consensual sex with their wives/partners. Variables associated with increased IIEF-5 score were increased WHOQoL score, increased body mass index (BMI), religion, and no consumption of alcohol. Increasing age, disease history, increased anxiety, and no consensual sex with their wife/partner were associated with a lower IIEF-5 score. If experiencing ED, 55.5% would seek help from medical doctors, 55.1% discussed it with their wives/partners, and 23.1% turned to their friends for help.

Conclusion: The prevalence of ED was high, although only 5.8% experienced moderate to severe ED. The key factors associated with ED were age, religion, disease history, BMI, alcohol consumption, anxiety, quality of life, and consensual sex with their wives/partners. Sexual health education should be more specifically targeted for men, including the provision of local sexual health-care services for men.

 

12. How do caregivers understand and respond to unsettled infant behaviour in Vietnam? A qualitative study

L. Murray, T. Tran, V. V. Thang, L. Cass and J. Fisher

Background: Unsettled infant behaviours are a common source of concern for new parents and have been associated with perinatal common mental disorders amongst women in high-income settings. There is little evidence about how unsettled infant behaviours are understood and managed in low and lower-middle income countries. This study aimed to describe caregivers' understandings of, and responses to, unsettled infant behaviours in Vietnam and their family caregiving contexts.

Methods: Women who were mothers of infants aged 0–6 months were purposively recruited from two sites in Thua Thien Hue Province, Vietnam (one urban and one rural). An additional group of women who were grandmothers were recruited by snowball sampling. Data were collected in semi-structured interviews about demographic information, infant feeding practices, descriptions of infant crying episodes, beliefs about why infants cry, settling strategies, infant sleeping arrangements and sources of advice on infant care. Translated interview transcripts were analysed thematically.

Results: Twenty-four interviews were undertaken (21 with mothers and 3 with grandmothers). Five major themes emerged from the data after analysis: infant settling techniques, sources of information on unsettled infant behaviour, understandings of the causes of infant crying, the emotional responses of caregivers and the intergenerational household context. Infants were commonly cared for by people from multiple generations, particularly during the day. Infant settling was characterized by attending to infants immediately, breastfeeding and bed-sharing with parents during the night. Most mothers received advice on caregiving from family members. Infant crying was attributed to hunger and loneliness, as well as traditional beliefs that the infant was being upset by ‘ghosts’ or becoming ‘hot’. Women described feeling anxious, frustrated and helpless in relation to unsettled behaviours amongst their infants.

Conclusions: Educational interventions on interpreting infant cues, infant sleep requirements and bed sharing may be appropriate in Vietnam if multiple generations are included and traditional beliefs about infant crying are addressed.

 

13. Longitudinal associations between bullying and mental health among adolescents in Vietnam

Ha Thi Hai Le, Huong Thanh Nguyen, Marilyn A. Campbell, Michelle L. Gatton, Nam T. Tran, Michael P. Dunne

Objectives: This study measured bullying roles across an academic year and examined how change in bullying experiences is associated with symptoms of depression, psychological distress, and suicidal ideation among adolescents in Vietnam.

Methods: 1424 students in middle and high schools completed two self-administered questionnaires, six months apart in 2014-2015.

Results: Students who were victimised often and those who were classified as highly involved as both victims and bullies at one or both survey times showed significantly higher levels of depression, psychological distress, and suicidal ideation than other students. The mental health of adolescents who were involved in bullying as a victim or bully remained at low levels was generally similar to those not involved in any bullying. However, females who had stable but low level in victimisation or bully-victim status had worse mental health than males with stable-low-level exposure.

Conclusion: This is the first longitudinal analysis of bullying among adolescents in Vietnam. Persistent and frequent bullying was strongly linked with poor mental health for males and females. A new observation is that Vietnamese girls appear to be more sensitive to low level but long-term bullying involvement than were boys.

 

14. Postnatal depressive symptoms amongst women in Central Vietnam: a cross-sectional study investigating prevalence and associations with social, cultural and infant factors

Linda Murray*, Michael P. Dunne, Thang Van Vo, Phuong Nguyen Thi Anh, Nigar G. Khawaja and Thanh Ngoc Cao

Background: This study investigated the prevalence and socio-cultural correlates of postnatal mood disturbance amongst women 18–45 years old in Central Vietnam. Son preference and traditional confinement practices were explored as well as factors such as poverty, parity, family and intimate partner relationships and infant health.

Methods: A cross-sectional study was conducted in twelve randomly selected Commune Health Centres from urban and rural districts of Thua Thien Hue Province, Vietnam. Mother-infant dyads one to six months postpartum were invited to participate. Questionnaires from 431 mothers (urban n = 216; rural n = 215) assessed demographic and family characteristics, traditional confinement practices, son preference, infant health and social capital. The Edinburgh Postnatal Depression Scale (EPDS) and WHO5 Wellbeing Index indicated depressive symptoms and emotional wellbeing. Data were analysed using general linear models.

Results: Using an EPDS cut-off of 12/13, 18.1 % (n = 78, 95 % CI 14.6 - 22.1) of women had depressive symptoms (20.4 % urban; 15.8 % rural). Contrary to predictions, infant gender and traditional confinement were unrelated to depressive symptoms. Poverty, food insecurity, being frightened of family members, and intimate partner violence increased both depressive symptoms and lowered wellbeing. The first model accounted for 30.2 % of the variance in EPDS score and found being frightened of one’s husband, husband’s unemployment, breastfeeding difficulties, infant diarrhoea, and cognitive social capital were associated with higher EPDS scores. The second model had accounted for 22 % of the variance in WHO5 score. Living in Hue city, low education, poor maternal competence and a negative family response to the baby lowered maternal wellbeing.

Conclusions: Traditional confinement practices and son preference were not linked to depressive symptoms among mothers, but were correlates of family relationships and wellbeing. Poverty, food insecurity, violence, infant ill health, and discordant intimate and family relationships were linked with depressive symptoms in Central Vietnam.

 

15. Hemoglobin Constant Spring is markedly high in women of an ethnic minority group in Vietnam: A community-based survey and hematologic features

Nguyen VH, Sanchaisuriya K, Wongprachum K, Nguyen MD, Phan TT, Vo VT, Sanchaisuriya P, Fucharoen S, Schelp FP.

A community-based survey was conducted to determine the prevalence and gene frequency of Hemoglobin Constant Spring (Hb CS) and other forms of thalassemia among an ethnic minority in Vietnam. A total of 298 ethnic minority women, the Có-Tu, participated. Hematological parameters and hemoglobin profiles were analyzed using standard automated analyzers. Alpha- and beta-thalassemia mutations were identified using polymerase chain reaction (PCR) based technology. Of the 298 women, 141 (47.3%) carried thalassemia genes. Hemoglobin Constant Spring (Hb CS) is the most common with a markedly high frequency of 0.143 (overall prevalence=26.2%). The heterozygous state of Hb CS was found in one-fifth (20.5%) of women participating. Seven women (2.4%) were Hb CS homozygote. The overall prevalence for Hb E was 13.8%, and 10.7% for α(+)-thalassemia. Other forms of thalassemia included 0.67% β-thalassemia, and 0.34% Hb Paksé. None of the participants had the α(0)-thalassemia gene. The study provides basic epidemiological information about Hb CS as well as other forms of thalassemia for a specific group of an ethnic minority in Vietnam. The data will be useful for further study on the distribution of thalassemia in Southeast Asia.