Income security during public health emergencies: the COVID-19 poverty trap in Vietnam

Association of federal poverty level with healthcare expenditures among opioids users in the United States (2008-2019): a serial cross-sectional study

BACKGROUND

Opioid users across federal poverty levels have varying healthcare consumption, which could influence public health policies to address the opioid crisis. To better understand this relationship, we evaluated the associations between federal poverty level (FPL) with healthcare costs and utilizations among adult opioid users in the United States (US).

METHODS

A serial cross-sectional study using pooled data (2008-2019) from the Medical Expenditure Panel Survey (MEPS) was used to evaluate the association between FPL with healthcare expenditures among a representative sample of the US adult population with > = 1 opioid prescription. FPL was defined as Poor/Near Poor-Income, Low-Income, Middle-Income, and High-Income. Healthcare expenditures included costs and resource utilization. Survey weights were applied to generate standard errors for the representative sample of the US population. Generalized linear models were constructed to evaluate the association between FPL and healthcare expenditures adjusting for confounders. FPL groups were stratified by insurance coverage, frequency of opioid prescriptions filled, and pain level to evaluate their impact on healthcare expenditures.

RESULTS

Total weighted sample was 27,289,263 respondents; 21.6% in Poor/Near Poor-Income, 14.9% in Low-Income, 28.6% in Middle-Income, and 34.9% in High-Income groups. The average annual increase in total healthcare costs for the Poor/Near Poor-Income group was $451 (95% CI: $142-$761), $275 (95% CI: $48-$502) for the Low-Income group, $640 (95% CI: $447-$834) for the Middle-Income group, and $618 (95% CI: $360-$877) for the High-Income group. Between-group comparisons yielded significant increases in average annual total healthcare costs for Middle- and High-Income groups versus Low-Income group; significant increases in average annual emergency room costs between Middle- versus Low-Income groups, and significant increases in average annual inpatient costs between Middle-Income versus Poor/Near Poor- and Low-Income groups. Stratified analyses yielded several significant increases in average annual costs and expenditures. However, no differences were reported for respondents who were uninsured across FPL groups.

CONCLUSIONS

Respondents across FPL groups consumed healthcare at various rates, particularly when stratified by insurance coverage, frequency of opioid prescriptions filled, and pain level. FPL plays an important role in healthcare consumption, but further research is needed to understand these mechanisms and their impact on the opioid crisis.

Determinants of catastrophic costs among households affected by multi-drug resistant tuberculosis in Ho Chi Minh City, Viet Nam: a prospective cohort study

BACKGROUND

Globally, most people with multidrug-resistant tuberculosis (MDR-TB) and their households experience catastrophic costs of illness, diagnosis, and care. However, the factors associated with experiencing catastrophic costs are poorly understood. This study aimed to identify risk factors associated with catastrophic costs incurrence among MDR-TB-affected households in Ho Chi Minh City (HCMC), Viet Nam.

METHODS

Between October 2020 and April 2022, data were collected using a locally-adapted, longitudinal WHO TB Patient Cost Survey in ten districts of HCMC. Ninety-four people with MDR-TB being treated with a nine-month TB regimen were surveyed at three time points: after two weeks of treatment initiation, completion of the intensive phase and the end of the treatment (approximately five and 10 months post-treatment initiation respectively). The catastrophic costs threshold was defined as total TB-related costs exceeding 20% of annual pre-TB household income. Logistic regression was used to identify variables associated with experiencing catastrophic costs. A sensitivity analysis examined the prevalence of catastrophic costs using alternative thresholds and cost estimation approaches.

RESULTS

Most participants (81/93 [87%]) experienced catastrophic costs despite the majority 86/93 (93%) receiving economic support through existing social protection schemes. Among participant households experiencing and not experiencing catastrophic costs, median household income was similar before MDR-TB treatment. However, by the end of MDR-TB treatment, median household income was lower (258 [IQR: 0-516] USD vs. 656 [IQR: 462-989] USD; p = 0.003), and median income loss was higher (2838 [IQR: 1548-5418] USD vs. 301 [IQR: 0-824] USD; p < 0.001) amongst the participant households who experienced catastrophic costs. Being the household's primary income earner before MDR-TB treatment (aOR = 11.2 [95% CI: 1.6-80.5]), having a lower educational level (aOR = 22.3 [95% CI: 1.5-344.1]) and becoming unemployed at the beginning of MDR-TB treatment (aOR = 35.6 [95% CI: 2.7-470.3]) were associated with experiencing catastrophic costs.

CONCLUSION

Despite good social protection coverage, most people with MDR-TB in HCMC experienced catastrophic costs. Incurrence of catastrophic costs was independently associated with being the household's primary income earner or being unemployed. Revision and expansion of strategies to mitigate TB-related catastrophic costs, in particular avoiding unemployment and income loss, are urgently required.

Governing public health emergencies during the coronavirus disease outbreak: Lessons from four Chinese cities in the first wave

The ongoing coronavirus disease (COVID-19) pandemic has had a far-reaching impact on urban living, prompting emergency preparedness and response from public health governance at multiple levels. The Chinese government has adopted a series of policy measures to control infectious disease, for which cities are the key spatial units. This research traces and reports analyses of those policy measures and their evolution in four Chinese cities: Zhengzhou, Hangzhou, Shanghai and Chengdu. The theoretical framework stems from conceptualisations of urban governance and its role in public health emergencies, wherein crisis management and emergency response are highlighted. In all four cities, the trend curves of cumulative diagnosed cases, critical policies launched in key time nodes and local governance approaches in the first wave were identified and compared. The findings suggest that capable local leadership is indispensable for controlling the coronavirus epidemic, yet local governments' approaches are varied, contributing to dissimilar local epidemic control policy pathways and positive outcomes in the fight against COVID-19. The effectiveness of disease control is determined by how local governments' measures have adapted to geospatial and socioeconomic heterogeneity. The coordinated actions from central to local governments also reveal an efficient, top-down command transmission and execution system for coping with the pandemic. This article argues that effective control of pandemics requires both a holistic package of governance strategies and locally adaptive governance measures/processes, and concludes with proposals for both a more effective response at the local level and identification of barriers to achieving these responses within diverse subnational institutional contexts.

Household Shocks and Adolescent Well-Being in Peru

This paper explores the linkages between exposure to household shocks across early life and children's educational and well-being outcomes in Peru. We use longitudinal survey data for a sample of 1713 children from five rounds of the Young Lives Survey to investigate how exposure to shocks across early life is linked to test scores and well-being in adolescence and to determine the extent to which critical periods of shock exposure exist. We expand on prior work by assessing the relationship between early childhood shocks and broader metrics of adolescent well-being beyond cognitive outcomes and by evaluating the cumulative impact of shocks over the course of a child's early life. We find that exposure to a greater number of shocks across early life is negatively associated with reading and vocabulary test scores. In addition, shock exposure in adolescence-versus earlier in childhood-has the strongest negative association with testing and well-being outcomes, suggesting that older children's time and household resources may be diverted away from learning and well-being in response to shocks. In light of increasingly frequent and severe weather events associated with climate change, as well as recent large-scale economic and health crises, policies aimed at supporting the most vulnerable children should be considered to alleviate the negative consequences of shocks on children's educational outcomes and well-being.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11113-023-09787-x.

Out-of-pocket expenditure and catastrophic costs due to COVID-19 in Indonesia: A rapid online survey

Background

The Corona Virus Disease 2019 (COVID-19) pandemic has created a substantial socioeconomic impact, particularly in developing countries such as Indonesia.

Purposes/objectives

This study aimed to describe the COVID-19-related out-of-pocket spending of Indonesian citizens and the proportion of whom experienced catastrophic health spending during the COVID-19 pandemic using the patient's perspective.

Methodology

We conducted a rapid cross-sectional online survey across provinces in Indonesia to capture participants' experiences due to COVID-19. Data were collected between September 23rd to October 7th of 2021 including demographics, income, and expenditures. Descriptive statistics were used to analyze the respondents' characteristics. Patients's perspective of total cost was estimated from out-of-pocket of COVID-19 direct costs and compared them to total expenditure. If the proportion of COVID-19 total costs exceeded 40% of the total expenditure, the respondents were deemed to have faced catastrophic costs.

Results

A total of 1,859 respondents answered the questionnaire. The average monthly income and expenditure of respondents were 800 USD, and 667 USD respectively. The monthly expenditure was categorized into food expenditure (367 USD) and non-food expenditure (320 USD). The average of COVID-19-related monthly expenditure was 226 USD, including diagnostic expenditure (36 USD), preventive expenditure (58 USD), medical expenditure (37 USD for COVID-19 treatment; and 57 USD for post-COVID-19 medical expenses), and non-medical expenditure (30 USD). Analysis showed that 18.6% of all respondents experienced catastrophic costs while 38.6% of the respondents who had COVID-19 treatment experienced catastrophic costs.

Conclusion

The high proportion of catastrophic costs among respondents suggests the need for COVID-19 social protection, especially for COVID-19 diagnostic and prevention costs. The survey findings have led the government to increase the benefit coverage other than medical costs at the hospitals.

Changes in health-related quality of life scores among low-income patients on social welfare programs in Japan during the COVID-19 pandemic: a single-center repeated cross-sectional study

BACKGROUND

Low-income is one of the well-established determinants of people's health and health-related behavior, including susceptibility to the coronavirus disease 2019 (COVID-19) infection. Two social welfare services are available in Japan to support financial and medical care among low-income patients: Public Assistance (PA), which provide both minimum income and medical costs; and Free/Low-Cost Medical Care (FLCMC), wherein only medical costs were covered. In this study, changes in Health-Related Quality of Life (HRQOL) scores of low-income patients on PA and FLCMC, before and after COVID-19 pandemic, were described and compared against those that are not utilizing the said services (comparison group) to evaluate the contribution of social welfare services in protecting the HRQOL of the beneficiaries during the pandemic.

METHODS

We used repeated cross-sectional data of adult beneficiaries of FLCMC and PA, as well as those without social welfare services, who regularly visit the Kamigyo clinic in Kyoto, Japan. We collected the data from 2018 and 2021 using a questionnaire on patients' socioeconomic attributes and the Japanese version of Medical Outcomes Study 12-Item Short Form Health Survey (SF-12). The Japanese version of SF-12 can calculate the three components scores: physical health component summary (PCS), the mental health component summary (MCS), and the role-social component summary (RCS), which can be transformed to a 0-100 range scale with a mean of 50 and standard deviation of 10.

RESULTS

Data of 200 and 174 beneficiaries in 2018 and 2021, respectively, were analyzed. Low-income patients on social welfare services had lower PCS, and RCS than the comparison group in both years. Multiple linear regression analyses with cluster-adjusted standard error estimator showed that the decline in MCS was significantly higher among FLCMC beneficiaries than in those without welfare services (Beta: -4.71, 95% Confidence Interval [CI]: -5.79 to -3.63, p < 0.01), and a decline in MCS among PA recipients was also observed (Beta: -4.27, 95% CI: -6.67 to -1.87 p = 0.02).

CONCLUSIONS

Low-income beneficiaries of social welfare may have experienced mental health deterioration during the COVID-19 pandemic. To maintain healthy lives during the pandemic, additional support on mental health for low-income recipients of social welfare services may be required.

Factors associated with depression, anxiety, and stress symptoms among men in a rural area in Vietnam during COVID-19

Background

The COVID-19 pandemic has affected health and well-being worldwide, and its psychological effects are receiving substantial attention in the scientific literature. Research to date shows that the pandemic has increased prevalences of depression, anxiety, and stress. This study aimed to estimate the prevalence of mental health symptoms and identify the associated factors among men in a rural area of Vietnam during the COVID-19 pandemic.

Methods and findings

During July 15-31, 2020, we conducted a cross-sectional survey of 1,085 men from 18 years old in 11 rural districts in Thanh Hoa province, Vietnam, and assessed their mental health using the Depression, Anxiety and Stress Scale - 21 Items (DASS-21). Outcomes assessed were have a symptom of depression, anxiety, and stress; risk factors measured included age, religion, marital status, education, occupation, and financial status. Multiple linear regression was performed to determine the statistical significance of associations between risk factors and mental health symptoms. Findings showed that the prevalences of having a symptom of depression, anxiety and stress among participants were 6.39, 9.72, and 5.65%, respectively. Regression model showed being younger (95% CI: -0.030; -0.004, p = 0.001), men had high school degree (95% CI: -0.671; -0.074, p = 0.014), men living in nearly poor houshoulds (95% CI: 0.067, 1.905, p < 0.05) and poor housholds (95% CI: 0.608; 2.721, p < 0.05) had significantly lower depression scores than others.

Conclusion

Prevalences of having symptoms of depression, anxiety and stress were much higher than in similar previous research in rural Vietnam, suggesting that mental health problems among men in this setting became more common during the COVID-19 pandemic. Age, religion, level of education and family income status were statistically significant predictors of mental health problems. These findings provide useful insights into the impact of pandemics on mental health.

Mapping COVID-19 related research from Vietnam: a scoping review

Introduction

The situation of COVID-19 pandemic is becoming more complex. The research institutes should focus on the most important challenge related to this outbreak at the national level. We aim to realize this scoping review to map publications on COVID-19 in Vietnam in order to guide research priorities and policies in the country.

Methods

This study was conducted at the Thai Binh University of Medicine and Pharmacy, from May to August 2020, according to the guidance for conducting systematic scoping review.

Results

A total of 72 studies met the inclusion criteria. The most frequent publications were original articles (27.8%), followed by letter to editor/correspondence (26.4%). According to the research priorities for COVID-19 set by the WHO, 41.7% studies focused on control and prevention of COVID-19, but none of studies on personal protective equipment or protocol for healthcare workers' safety were conducted. 12.5% studies carried out a thorough investigation into epidemiology of the COVID-19 pandemic in Vietnam. Virology and genomics, natural history of the virus and its transmission in Vietnam were described by 18.1% papers. Only one study was conducted in terms of development for candidate therapeutics.

Conclusion

We call for national investigation on treatment against SARS-CoV-2 and protocol for medical staff protection. The government and academic institutions should work in collaboration with international stakeholders, including the WHO, to combat together the COVID-19.

Fuzzy Clustering Methods to Identify the Epidemiological Situation and Its Changes in European Countries during COVID-19

The main research question concerned the identification of changes in the COVID-19 epidemiological situation using fuzzy clustering methods. This research used cross-sectional time series data obtained from the European Centre for Disease Prevention and Control. The identification of country types in terms of epidemiological risk was carried out using the fuzzy c-means clustering method. We also used the entropy index to measure the degree of fuzziness in the classification and evaluate the uncertainty of epidemiological states. The proposed approach allowed us to identify countries' epidemic states. Moreover, it also made it possible to determine the time of transition from one state to another, as well as to observe fluctuations during changes of state. Three COVID-19 epidemic states were identified in Europe, i.e., stabilisation, destabilisation, and expansion. The methodology is universal and can also be useful for other countries, as well as the research results being important for governments, politicians and other policy-makers working to mitigate the effects of the COVID-19 pandemic.

Early Evaluation of an Ultra-Portable X-ray System for Tuberculosis Active Case Finding

X-ray screening is an important tool in tuberculosis (TB) prevention and care, but access has historically been restricted by its immobile nature. As recent advancements have improved the portability of modern X-ray systems, this study represents an early evaluation of the safety, image quality and yield of using an ultra-portable X-ray system for active case finding (ACF). We reported operational and radiological performance characteristics and compared image quality between the ultra-portable and two reference systems. Image quality was rated by three human readers and by an artificial intelligence (AI) software. We deployed the ultra-portable X-ray alongside the reference system for community-based ACF and described TB care cascades for each system. The ultra-portable system operated within advertised specifications and radiologic tolerances, except on X-ray capture capacity, which was 58% lower than the reported maximum of 100 exposures per charge. The mean image quality rating from radiologists for the ultra-portable system was significantly lower than the reference (3.71 vs. 3.99, p < 0.001). However, we detected no significant differences in TB abnormality scores using the AI software (p = 0.571), nor in any of the steps along the TB care cascade during our ACF campaign. Despite some shortcomings, ultra-portable X-ray systems have significant potential to improve case detection and equitable access to high-quality TB care.

Prevalence and factors associated with catastrophic health expenditure among slum and non-slum dwellers undergoing emergency surgery in a metropolitan area of South Western Nigeria

BACKGROUND

Out of Pocket (OOP) payment continues to persist as the major mode of payment for healthcare in Nigeria despite the introduction of the National Health Insurance Scheme (NHIS). Although the burden of health expenditure has been examined in some populations, the impact of OOP among slum dwellers in Nigeria when undergoing emergencies, is under-researched. This study sought to examine the prevalence, factors and predictors of catastrophic health expenditure amongst selected slum and non-slum communities undergoing emergency surgery in Southwestern Nigeria.

METHODS

The study utilised a descriptive cross-sectional survey design to recruit 450 households through a multistage sampling technique. Data were collected using pre-tested semi-structured questionnaires in 2017. Factors considered for analysis relating to the payer were age, sex, relationship of payer to patient, educational status, marital status, ethnicity, occupation, income and health insurance coverage. Variables factored into analysis for the patient were indication for surgery, grade of hospital, and type of hospital. Households were classified as incurring catastrophic health expenditure (CHE), if their OOP expenditure exceeded 5% of payers' household budget. Analysis of the data took into account the multistage sampling design.

RESULTS

Overall, 65.6% (95% CI: 55.6-74.5) of the total population that were admitted for emergency surgery, experienced catastrophic expenditure. The prevalence of catastrophic expenditure at 5% threshold, among the population scheduled for emergency surgeries, was significantly higher for slum dwellers (74.1%) than for non-slum dwellers (47.7%) (F = 8.59; p = 0.019). Multiple logistic regression models revealed the significant independent factors of catastrophic expenditure at the 5% CHE threshold to include setting of the payer (whether slum or non-slum dweller) (p = 0.019), and health insurance coverage of the payer (p = 0.012). Other variables were nonetheless significant in the bivariate analysis were age of the payer (p = 0.017), income (p<0.001) and marital status of the payer (p = 0.022).

CONCLUSION

Although catastrophic health expenditure was higher among the slum dwellers, substantial proportions of respondents incurred catastrophic health expenditure irrespective of whether they were slum or non-slum dwellers. Concerted efforts are required to implement protective measures against catastrophic health expenditure in Nigeria that also cater to slum dwellers.

Using a household-structured branching process to analyse contact tracing in the SARS-CoV-2 pandemic

We explore strategies of contact tracing, case isolation and quarantine of exposed contacts to control the SARS-CoV-2 epidemic using a branching process model with household structure. This structure reflects higher transmission risks among household members than among non-household members. We explore strategic implementation choices that make use of household structure, and investigate strategies including two-step tracing, backwards tracing, smartphone tracing and tracing upon symptom report rather than test results. The primary model outcome is the effect of contact tracing, in combination with different levels of physical distancing, on the growth rate of the epidemic. Furthermore, we investigate epidemic extinction times to indicate the time period over which interventions must be sustained. We consider effects of non-uptake of isolation/quarantine, non-adherence, and declining recall of contacts over time. Our results find that, compared to self-isolation of cases without contact tracing, a contact tracing strategy designed to take advantage of household structure allows for some relaxation of physical distancing measures but cannot completely control the epidemic absent of other measures. Even assuming no imported cases and sustainment of moderate physical distancing, testing and tracing efforts, the time to bring the epidemic to extinction could be in the order of months to years. This article is part of the theme issue 'Modelling that shaped the early COVID-19 pandemic response in the UK'.

Can Health Human Capital Help the Sub-Saharan Africa Out of the Poverty Trap? An ARDL Model Approach

This article explores the impact of health human capital on the poverty trap in Sub-Saharan Africa by autoregressive distribution lag model. In the long run, there is no evidence that health human capital can help the Sahara out of the poverty trap. While health human capital has a significant effect on poverty reduction in the short term. There is a threshold effect in the poverty reduction model of healthy human capital. When the economic development level reaches the threshold, the effect of poverty reduction is more obvious and deeper. The extended Solow economic growth model also proved that if the external human capital breaks through the threshold, it can make developing countries get rid of the poverty trap. Therefore, the economic development brought about by health care expenditure must benefit the poor in Sub-Saharan Africa and allow them to enjoy the welfare of social security.

Relationship between wealth and emotional well-being before, during, versus after a nationwide disease outbreak: a large-scale investigation of disparities in psychological vulnerability across COVID-19 pandemic phases in China

OBJECTIVES

This research investigated whether certain population segments might be more psychologically vulnerable in different phases of a pandemic. Specifically, the research examined how disparities in wealth might be associated with differences in emotional well-being before, during, versus after the nationwide COVID-19 outbreak in China.

SETTING, PARTICIPANTS AND OUTCOME MEASURES

In this large-scale cross-sectional study, three rounds of nationally representative data collection (N=27 760) were conducted immediately before (December 2019), in the midst of (February 2020), versus immediately after (April 2020) the countrywide COVID-19 outbreak in China. Participants' emotional well-being, wealth (income, property ownership) and demographic information were measured using established instruments. Statistical analyses examined relationships between disparities in different types of wealth and emotional well-being across the pandemic phases.

RESULTS

Although the onset of the coronavirus outbreak substantially degraded emotional well-being, having a higher income was associated with better emotional well-being during the outbreak. Property owners experienced a larger drop in emotional well-being during the outbreak than non-owners; however, the former was not emotionally worse off than the latter during the outbreak. After the nationwide COVID-19 outbreak had been contained and the economy reopened, those with more wealth of either type again became better off in emotional well-being than those with less. The highest income segment even experienced better emotional well-being after the end of the nationwide outbreak than prior to the outbreak. In contrast, the lowest income segment became worse off in emotional well-being after the nationwide outbreak ended than before the outbreak began.

CONCLUSION

People with less wealth tend to be emotionally worse off throughout the different phases of a disease outbreak. In particular, even after an outbreak has been contained, the poor are less able to restore their psychological well-being. Policies and interventions are needed to address disparities in mental health in the age of pandemics.

Decision support system for ranking relevant indicators for reopening strategies following COVID-19 lockdowns

The pandemic caused by the spread of the SARS-CoV-2 virus forced governments around the world to impose lockdowns, which mostly involved restricting non-essential activities. Once the rate of infection is manageable, governments must implement strategies that reverse the negative effects of the lockdowns. A decision support system based on fuzzy theory and multi-criteria decision analysis principles is proposed to investigate the importance of a set of key indicators for post-COVID-19 reopening strategies. This system yields more reliable results because it considers the hesitation and experience of decision makers. By including 16 indicators that are utilized by international organizations for comparing, ranking, or investigating countries, our results suggest that governments and policy makers should focus their efforts on reducing violence, crime and unemployment. The provided methodology illustrates the suitability of decision science tools for tackling complex and unstructured problems, such as the COVID-19 pandemic. Governments, policy makers and stakeholders might find in this work scientific-based guidelines that facilitate complex decision-making processes.

Psychological Impacts of COVID-19 During the First Nationwide Lockdown in Vietnam: Web-Based, Cross-Sectional Survey Study

Background

The first nationwide lockdown due to the COVID-19 pandemic was implemented in Vietnam from April 1 to 15, 2020. Nevertheless, there has been limited information on the impact of COVID-19 on the psychological health of the public.

Objective

This study aimed to estimate the prevalence of psychological issues and identify the factors associated with the psychological impact of COVID-19 during the first nationwide lockdown among the general population in Vietnam.

Methods

We employed a cross-sectional study design with convenience sampling. A self-administered, online survey was used to collect data and assess psychological distress, depression, anxiety, and stress of participants from April 10 to 15, 2020. The Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety, and Stress Scale-21 (DASS-21) were utilized to assess psychological distress, depression, anxiety, and stress of participants during social distancing due to COVID-19. Associations across factors were explored using regression analysis.

Results

A total of 1385 respondents completed the survey. Of this, 35.9% (n=497) experienced psychological distress, as well as depression (n=325, 23.5%), anxiety (n=195, 14.1%), and stress (n=309, 22.3%). Respondents who evaluated their physical health as average had a higher IES-R score (beta coefficient [B]=9.16, 95% CI 6.43 to 11.89), as well as higher depression (B=5.85, 95% CI 4.49 to 7.21), anxiety (B=3.64, 95% CI 2.64 to 4.63), and stress (B=5.19, 95% CI 3.83 to 6.56) scores for DASS-21 than those who rated their health as good or very good. Those who self-reported their health as bad or very bad experienced more severe depression (B=9.57, 95% CI 4.54 to 14.59), anxiety (B=7.24, 95% CI 3.55 to 10.9), and stress (B=10.60, 95% CI 5.56 to 15.65). Unemployment was more likely to be associated with depression (B=3.34, 95% CI 1.68 to 5.01) and stress (B=2.34, 95% CI 0.84 to 3.85). Regarding worries about COVID-19, more than half (n=755, 54.5%) expressed concern for their children aged <18 years, which increased their IES-R score (B=7.81, 95% CI 4.98 to 10.64) and DASS-21 stress score (B=1.75, 95% CI 0.27 to 3.24). The majority of respondents (n=1335, 96.4%) were confident about their doctor’s expertise in terms of COVID-19 diagnosis and treatment, which was positively associated with less distress caused by the outbreak (B=–7.84, 95% CI –14.58 to –1.11).

Conclusions

The findings highlight the effect of COVID-19 on mental health during the nationwide lockdown among the general population in Vietnam. The study provides useful evidence for policy decision makers to develop and implement interventions to mitigate these impacts.

Rapid response to the COVID-19 pandemic: Vietnam government's experience and preliminary success

Background

The COVID-19 pandemic has hit all corners of the world, challenging governments to act promptly in controlling the spread of the pandemic. Due to limited resources and inferior technological capacities, developing countries including Vietnam have faced many challenges in combating the pandemic. Since the first cases were detected on 23 January 2020, Vietnam has undergone a 3-month fierce battle to control the outbreak with stringent measures from the government to mitigate the adverse impacts. In this study, we aim to give insights into the Vietnamese government’s progress during the first three months of the outbreak. Additionally, we relatively compare Vietnam’s response with that of other Southeast Asia countries to deliver a clear and comprehensive view on disease control strategies.

Methods

The data on the number of COVID-19 confirmed and recovered cases in Vietnam was obtained from the Dashboard for COVID-19 statistics of the Ministry of Health (https://ncov.vncdc.gov.vn/). The review on Vietnam’s country-level responses was conducted by searching for relevant government documents issued on the online database ‘Vietnam Laws Repository’ (https://thuvienphapluat.vn/en/index.aspx), with the grey literature on Google and relevant official websites. A stringency index of government policies and the countries’ respective numbers of confirmed cases of nine Southeast Asian countries were adapted from the Oxford COVID-19 Government Response Tracker (https://www.bsg.ox.ac.uk/research/research-projects/coronavirus-government-response-tracker). All data was updated as of 24 April 2020.

Results

Preliminary positive results have been achieved given that the nation confirmed no new community-transmitted cases since 16 April and zero COVID-19 – related deaths throughout the 3-month pandemic period. To date, the pandemic has been successfully controlled thanks to the Vietnamese government’s prompt, proactive and decisive responses including mobilization of the health care systems, security forces, economic policies, along with a creative and effective communication campaign corresponding with crucial milestones of the epidemic’s progression.

Conclusions

Vietnam could be one of the role models in pandemic control for low-resource settings. As the pandemic is still ongoing in an unpredictable trajectory, disease control measures should continue to be put in place in the foreseeable short term.

Income security during periods of ill health: a scoping review of policies, practice and coverage in low-income and middle-income countries

The COVID-19 pandemic is a reminder that insufficient income security in periods of ill health leads to economic hardship for individuals and hampers disease control efforts as people struggle to stay home when sick or advised to observe quarantine. Evidence on income security during periods of ill health is growing but has not previously been reviewed as a full body of work concerning low-income and middle-income countries (LMICs). We performed a scoping review to map the range, features, coverage, protective effects and equity of policies that aim to provide income security for adults whose ill health prevents them from participating in gainful work. A total of 134 studies were included, providing data from 95% of LMICs. However, data across the majority of these countries were severely limited. Collectively the included studies demonstrate that coverage of contributory income-security schemes is low, especially for informal and low-income workers. Meanwhile, non-contributory schemes targeting low-income groups are often not explicitly designed to provide income support in periods of ill health, they can be difficult to access and rarely provide sufficient income support to cover the needs of eligible recipients. While identifying an urgent need for more research on illness-related income security in LMICs, this review concludes that scaling up and diversifying the range of income security interventions is crucial for improving coverage and equity. To achieve these outcomes, illness-related income protection must receive greater recognition in health policy and health financing circles, expanding our understanding of financial hardship beyond direct medical costs.