Health services for reproductive tract infections among female migrant workers in industrial zones in Ha Noi, Viet Nam: an in-depth assessment

Stigmatizing Attitudes toward People Living with HIV among Young Women Migrant Workers in Vietnam

Despite intensive HIV education and prevention efforts in the past few years, stigmatizing attitudes toward people living with HIV (PLWH) remain a major barrier to HIV prevention and treatment efforts in Vietnam. The purpose of this study was to examine the prevalence of stigmatizing attitudes regarding HIV and identify correlative factors that impact the perceptions of PLWH among a heretofore overlooked demographic in Vietnamese society: women who are migrant workers in designated industrial zones (IZs). A cross-sectional study was conducted among 1061 women migrant workers aged 18 to 29 from January 2020 to November 2020 in Hanoi, Vietnam. Stigmatizing attitudes toward PLWH were measured using a four-item scale. Multiple logistic regression was conducted to examine the factors associated with stigmatizing attitudes. Our findings indicate both substantial levels of stigma persisting among this demographic group as well as the influence of important mitigating factors on the expression of HIV-related stigma. Over seventy-six percent (76.2%) of the participants reported having at least one of the four stigmatizing attitudes. Greater levels of stigmatizing attitudes toward PLWH were significantly associated with lower HIV knowledge, lower levels of education, and identifying as Kinh (the ethnic majority in Vietnam). Additionally, this study found that questions framing HIV infection through a familial lens were significantly associated with lower rates of stigmatizing responses. The high overall levels of stigmatizing attitudes toward PLWH among the study participants suggests that there is an urgent need for the development of culturally appropriate interventions and outreach education activities to reduce stigmatizing attitudes toward PLWH among women who are migrant workers working in the IZs in Vietnam. This study adds to both the existing literature and current efforts and policies around HIV in Vietnam by empirically suggesting that familial-based messaging may be a powerful potential narrative for interventions addressing HIV-related issues such as stigma.

Determinants of Differences in Health Service Utilization between Older Rural-to-Urban Migrant Workers and Older Rural Residents: Evidence from a Decomposition Approach

Background: The widening gap in health service utilization between different groups in mainland China has become an important issue that cannot be avoided. Our study explored the existence of differences and the causes of the differences in the health service utilization of older rural-to-urban migrant workers in comparison to older rural dwellers. Further, our study explored socioeconomic differences in health service utilization. Methods: The data from the China Labor-Force Dynamic Survey in 2016, the data from the Urban Statistical Yearbook in 2016, and the Statistical Bulletin were used. Our study applied the latest Andersen Model according to China’s current situation. Before we studied health service utilization, we used Coarsened Exact Matching to control the confounding factors. After matching, 2314 respondents were successfully matched (859 older rural-to-urban migrant workers and 1455 older rural dwellers). The Fairlie decomposition method was used to analyze the differences and the sources of health service utilization between older rural-to-urban migrant workers and their rural counterparts. Results: After matching, the probability two-weeks outpatient for older rural-to-urban migrant workers (5.59%) was significantly lower than older rural dwellers (7.57%). The probability of inpatient for older rural-to-urban migrant workers (5.59%) was significantly lower than older rural dwellers (9.07%). Overall, 17.98% of the total difference for two-week outpatient utilization was due to the observed influence factors. Moreover, 71.88% of total difference in inpatient utilization was due to the observed influence factors. Income quantiles (49.57%), health self-assessments (80.91%), and the sex ratio in the community (−102.29%) were significant in the differences in inpatient utilization. Conclusions: The findings provide important insights into the socioeconomic differences in health service utilization among older rural-to-urban migrant workers and older rural residents in China. These insights urge the government to take full account of the heterogeneity in designing health security system reform and public health interventions targeting vulnerable groups.

Unmet Healthcare Needs and Their Determining Factors among Unwell Migrants: A Comparative Study in Shanghai

The purpose of this study was to analyze the health status and unmet healthcare needs, and the impact of related factors, of unwell migrants in Shanghai. A total of 10,938 respondents, including 934 migrants and 10,004 non-migrants, were interviewed in Shanghai’s Sixth Health Service Survey. Descriptive statistics were utilized to present the prevalence of health status and unmet healthcare needs. Binary logistic regression analysis was performed to explore the relationships between predisposing factors, enabling factors, need factors, and health-related behavior and unmet healthcare needs in the Anderson health service utilization model. This study indicated the percentages of migrants having a fair or poor self-evaluated health status (21.09%) and suffering from chronic diseases (72.91%) were lower than those of non-migrants (28.34% and 88.64%, respectively). Migrants had higher percentages of unmet hospitalization needs (88.87%), unmet outpatient care needs (44.43%), and self-medication (23.98%) than those of non-migrants (86.24%, 37.95%, 17.97%, respectively). Migrants enrolled in Urban Employee Basic Medical Insurance were more likely to utilize hospitalization services (OR = 1.457) than those enrolled in other health insurances or uninsured. Need factors had impacts on unwell migrants’ unmet healthcare needs. Other factors, including age and health behavior, were also found to significantly affect unwell migrants’ unmet health service needs. Specific gaps continue to exist between unwell migrants and non-migrants regarding the accessibility of local health services. Flexible policies, such as enhancing the health awareness of migrants and eliminating obstacles for migrants to access medical services, should be implemented to provide convenient and affordable healthcare services to unwell migrants.

Gaps of Knowledge about HIV and Sexually Transmitted Infections Among Industrial Workers in Northern Vietnam

Industrial workers are a vulnerable population for HIV and sexually transmitted infections (STIs). This cross-sectional study assessed the general knowledge about sexually transmitted infections (STIs) and HIV transmission risk among 289 industrial workers in Northern Vietnam. Results indicated that most workers could identify common routes of HIV transmissions and were aware of common STIs. However, insufficient knowledge about HIV transmission via anal sex practices, as well as common signs and symptoms of STIs were observed. Gender, marital status, education, locality status and health information sources were associated with the knowledge. This study reveals a gap of knowledge about HIV and other STIs, and suggested further tailored education interventions to improve the knowledge and promote sexual health-seeking behaviors in industrial workers.

Sexual Risk Behaviors, HIV Prevalence and Access to Reproductive Health Services Among Young Women Migrant Workers in the Industrial Zones in Vietnam

Background: Young migrant workers working in the industrial zones (IZ) in low and middle-income countries are at risk for HIV and other sexually transmitted diseases. This study examines the sex-related risks of young women migrant workers in the IZ in Vietnam. Materials and Methods: This cross-sectional survey was conducted among 1,061 young migrant women working in the IZ park in Hanoi, Vietnam. Multivariate logistic regression analysis was used to identify factors associated with HIV testing and condom use at last sex. Results: A total of 1,061 young women migrant workers completed the survey in which 652 participants consented to take the initial rapid HIV test. All but one participant tested negative indicating a HIV prevalence of 150 (95% CI: 27-860) per 100,000 population among this population. There were no differences in sexual behavior, use of sexual and reproductive health services, HIV knowledge, perceived HIV risk or alcohol use between those who were HIV tested and those not tested. Single participants reported high rates of first sex while living in the IZ and high rates of condom use during the first-time sex, however, they had low levels of condom use at last sex. While the majority of married participants used the SRH/HIV services, nearly 80% of the single participants who reported having sex never used SRH/HIV services since living in the IZ. However, single participants were over 4 times more likely to use condoms at last sex compared to married participants (OR = 4.67; 95%CI = 2.96-7.85). Participants with vocational school or higher education was more likely to use condom (OR = 2.19; 95%CI = 1.05-4.57). Neither HIV knowledge or alcohol use were associated with condom use. Conclusions: Although HIV prevalence is very low among young women workers in the IZ in Vietnam, a significant number of them engaged in risky sexual behavior and low levels of condom use at last sex as well as low level of using SRH/HIV services highlights a need to develop interventions that provide tailored-made and cultural appropriate SRH education for unmarried female migrant workers to prevent risky sexual behaviors, sexually transmitted diseases and unwanted pregnancy.

Reaching women at work with health programming in Bangladesh: results of difference-in-differences analysis among female factory workers

The rapid growth of Bangladesh’s ready-made garment sector has transformed the country’s economy while also employing a predominantly female workforce. Companies have begun collaborating with NGOs to provide health messages to and expand health services for workers. This study evaluates the effect of the Health Enables Return (HER) health model’s approach of using peer health educators to deliver health messages and increased availability of health products. Using repeated cross-sectional data from female workers in HERhealth and comparison factories between May 2015 and March 2017, baseline (n = 1704) and endline (n = 1503) samples were matched on eight characteristics and then difference-in-differences estimations were used to determine the effect of the HERhealth model on knowledge and behaviours. The average changes over time in knowledge and behaviours were statistically different between the HERhealth and comparison factories. Knowledge of when a woman is at higher risk for pregnancy during her menstrual cycle increased from baseline to endline in both groups but was 12 percentage points greater in the HERhealth factories than in the comparison. An increase in family planning use among ever-married women was observed in the HERhealth factories but decreased in the comparison factories leading to a 12 percentage point difference-in-differences. The greatest effect of the HERhealth model was observed on women’s use of sanitary products for menstrual management which significantly increased in both groups, but the increase was 35% greater in the HERhealth factories. The HERhealth model is effective in increasing knowledge and in improving health behaviours when health products are available in factory infirmaries.

COVID-19 Stressors on Migrant Workers in Vietnam: Cumulative Risk Consideration

This study explored the impact of COVID-19 on migrant workers in Vietnam, using a cumulative risk assessment (CRA) framework which comprises four domains (workplace, environment, individual and community). A cross-sectional study was conducted. Data were collected in 2020 through a self-administered questionnaire with 445 domestic migrant workers in two industrial zones in two northern provinces (Bac Ninh and Ninh Binh) in Vietnam. The majority of migrant workers were female (65.2%), aged between 18 and 29 years old (66.8%), and had high school or higher education level qualifications. Most migrant workers had good knowledge about preventive measures (>90%) and correct practices on COVID-19 prevention (81.1%). Three health risk behaviors were reported: 10% of participants smoked, 25% consumed alcohol and 23.1% were engaged in online gaming. In terms of workplace, occupational working conditions were good. Noise was the most commonly reported hazard (29%). Regarding environment, about two-thirds of migrant workers lived in a small house (<36 m2). Most participants (80.4%) lived with their families. About community domain, many reported low salary or losing their job during January-July, 2020. Most migrants received information about COVID-19. The migrant workers suffered from poor health and low occupational safety, fear of job loss and income cut, poor housing and living conditions and limited access to public services. The holistic approach to address stressors is recommended to improve health and safety of migrant workers.

Characterize health and economic vulnerabilities of workers to control the emergence of COVID-19 in an industrial zone in Vietnam

The detection of first COVID-19 infected industrial worker in Vietnam on 13 April 2020 prompted timely effort to examine the health problems, behaviors, and health services access of industrial workers to inform effective and appropriate COVID-19 control measures, minimizing the risk of industrial sites becoming the next disease cluster. A search strategy involving search terms corresponding to 'health', 'industrial worker', and 'Vietnam' was applied to search for related papers published in English on Web of Science, PubMed, and Google Scholar. Duplicates were removed, and relevant data were extracted from the full text of remaining publications. Results showed that underlying health problems, including respiratory system problems, were common among industrial workers. Many suffered occupational diseases and/or work-related injuries. Self-treatment (without medication) was the most used method when having health problems (by 28.2-51% of participants), followed by visiting commune health centers (24%) and self-medication (20.3%). Findings suggest a high risk of disease spreading among industrial workers and of them suffering more severe conditions when infected. Economic vulnerabilities may be the reason for workers' reluctance to taking time off work to attend hospital/clinic. These imply a need for involving local pharmacies, commune health centers, traditional health providers or village health collaborators as local health gatekeepers who are the first point of detecting and reporting of suspected COVID-19 cases, as well as a channel where accurate information regarding COVID-19, protective equipment, and intervention packages can be delivered. Having COVID-19 testing centers at or near industrial sites are also recommended.

Prevalence of musculoskeletal symptoms among industrial employees in a modern industrial region in Beijing, China

BACKGROUND

Growing industrialization of China exposes its labor population to the risk of musculoskeletal disorders (MSDs). This study aimed to investigate the prevalence and risk factors of MSDs in a modern industrial region of Beijing.

METHODS

A cross-sectional study included 1415 employees in six industrial companies was conducted between January 2018 and May 2018 in Fangshan district, Beijng, China. Nordic Musculoskeletal Questionnaire (NMQ) was used to collect the information about MSDs. Demographic factors, lifestyle factors, health and medical factors, and work-related factors were collected as independent variables. Descriptive statistics, the chi-squared (χ) test, and binary logistic regression analysis were used to analyze data.

RESULTS

Among 1415 participants, 498 reported MSDs. The regions involved were the neck (25.16%), shoulders (17.17%), and upper back (13.29%). There was a significant statistical difference between frontline industrial workers and other staff in the prevalence of self-reported symptoms involving the shoulders (χ = 4.33, P = 0.037), wrists and hands (χ = 8.90, P = 0.003), and ankles and feet (χ = 12.88, P < 0.001). Increased age (P = 0.005, OR = 1.63; P = 0.001, OR = 2.33), a high or a low salary (P < 0.001, OR = 0.49; P < 0.001, OR = 0.30), night-shift (P = 0.027, OR = 1.46), two-week-history of illness and treatment (P = 0.004, OR = 5.60; P = 0.013, OR = 4.19), concurrent chronic diseases (P = 0.001, OR = 3.45; P = 0.092, OR = 7.81), limited access to health information (P = 0.004, OR = 0.49), and negative attitude towards seeking healthcare (P = 0.010, OR = 1.77; P = 0.009, OR = 2.75) were associated with MSDs in frontline workers. Female gender (P < 0.001, OR = 2.30), high education (P = 0.001, OR = 1.96), no exercises (P = 0.027, OR = 0.59), night-shift (P = 0.017, OR = 1.98), concurrent chronic diseases (P = 0.002, OR = 3.73; P = 0.020, OR = 13.42), limited access to health information (P = 0.013, OR = 0.53), far distance to medical institution (P = 0.009, OR = 1.83), and negative propensity (P = 0.009, OR = 1.94; P = 0.014, OR = 2.74) were associated with MSDs in other staffs.

CONCLUSIONS

The prevalence of MSDs among industrial employees has changed. Frontline workers had different prevalence and risk factors for MSDs compared with other employees. Negative propensity to healthcare, limited ways to obtain health knowledge, and concomitant chronic diseases were associated with MSDs. Surprisingly, highly educated and high-income employees had a higher risk of MSDs.

Premarital sex, contraceptive use among unmarried women migrant workers in industrial parks in Vietnam, 2015

Most of internal female migrants are young, at risk of unintended pregnancy, unsafe abortion. This paper aims to describe premarital sexual behaviors and contraceptive use among unmarried female migrant workers in industrial parks, Vietnam. A cross-sectional survey was completed with a sample of 2,996 workers aged 18-49 years. We found that premarital sex rate was 12.6%. Most of them were inconsistent contraceptive users. About 27.8% did not use any contraception in the last 6/months. Condom was the most popular contraceptive used (61.3%) and obtained through pharmacies, kiosk systems. Contraceptive use was significantly associated with age, education, private companies, and income.

Reproductive tract infection and related factors among female migrants working in industrial zones in Vietnam 2013-2014

We conducted this study to analyze factors related to reproductive tract infections (RTIs) among female migrant workers (FMWs) in four industrial zones across four regions in Vietnam. A analytical cross-sectional study was implemented with FMWs aged between 18 and 49 year old in four industrial zones in Hanoi, Da Nang, Ho Chi Minh (HCM) city and Binh Duong, Vietnam. Stratified sampling was used to select about 6400 married and unmarried FMWs. Cases were identified through self-reporting of female migrants concerning RTIs symtoms experienced in the 1 year prior to the study. Based on multivariate logistic regression results, we suggested that about 32% of FMWs reported having RTIs problems (27.6% in Hanoi, 30.3% in Danang, 36% in HCMC and 32.9% in Binhduong). We also identified different factors related to RTIs among different study sites. Marital status, level of education, social-economic status and numbers of migration were important related factors of RTIs.

mHealth information for migrants: an e-health intervention for internal migrants in Vietnam

Background

Socio-economic development in Vietnam has resulted in increased internal migration particularly among young women seeking employment opportunities in cities. Vietnamese female migrants who enter new environments often encounter the loss or neglect of their right to access sexual and reproductive health services. To address this, a mobile health (mHealth) intervention model was implemented over 12 months (2013–2014) in a factory in the Long Bien industrial zone of Hanoi, Vietnam.

Methods

The intervention provided sexual and reproductive health services for female migrants through text messaging, information booklets accompanied maps, and free counseling via a hotline. To evaluate the impact of the intervention, pre- and post-intervention data were collected to measure changes in women’s knowledge and practices related to sexual and reproductive health. Qualitative data in the form of personal interviews were also collected. The sample size for the baseline survey was 411 women, and for the post-intervention survey it was 482 women (the intervention involved an open cohort). The majority of women were unmarried and under the age of 25.

Results

Results indicate that there was high uptake of the intervention services and that most women found the services important and useful. In addition, there was evidence that the intervention (1) increased women’s knowledge of sexual and reproductive health (e.g., proper use of condoms, identification of high-risk behaviors such as having unprotected sex), and (2) fostered improved practices related to sexual and reproductive health (e.g., increased gynecological check-ups and use of condoms).

Conclusions

The study demonstrated the feasibility of implementing a multi-faceted intervention for migrant women working in an industrial zone in Hanoi, Vietnam as well as its successful uptake and some early positive effects. This can be used to inform future design and implementation of mHealth/eHealth intervention models for migrant and other vulnerable/hard to reach population.

UTILIZATION OF HEALTH CARE SERVICES AMONG INTERNAL MIGRANTS IN HANOI AND ITS CORRELATION WITH HEALTH INSURANCE: A CROSS-SECTIONAL STUDY

BACKGROUND

Economic transition (DoiMoi) in the 1980s in Viet Nam has led to internal migration, particularly rural-to-urban migration. Many studies suggested that there is a difference between non-migrants and migrants in using health care services. Current studies have mostly focused on migrants working in industrial zones (IZs) but migrants working in private small enterprises (PSEs) and seasonal migrants seem to be ignored. However, these two groups of migrants are more vulnerable in health care access than others because they usually work without labor contracts and have no health insurance. The study aims to compare the utilization of health care services and explore its correlated factors among these three groups.

METHODS

This cross-sectional study included 1800 non-migrants and migrants aged 18-55 who were selected through stratified sampling in Long Bien and Ba Dinh districts, Hanoi. These study sites consist of large industrial zones and many slums where most seasonal migrants live in. A structured questionnaire was used to collect information on health service utilization in the last 6 months before the study. Utilization of heath care services was identified as "an ill person who goes to health care centers to seek any treatment (i.e. both private and public health care centers)".

RESULTS

644 of 1800 participants reported having a health problem in the last 6 months before the study. Among these 644 people, 335 people used health care services. The percentage of non-migrants using health care service was the highest (67.6%), followed by migrants working in IZ (53.7%), migrants working in PSE (44%), and seasonal migrants (42%). Multivariate logistic regression showed migrants, especially seasonal migrants and migrants working in PSE, were less likely to use health care services (OR=0.35, p=0.016 and 0.38, p= 0.004, respectively), compared to non-migrants. The study also found that having no health insurance was a risk factor of the utilization (OR=0.29, p<0.001). Other factors such as gender, age, marital status, socioeconomic status, and monthly income were not related to the utilization of health care services.

CONCLUSION

Seasonal migrants have the worst utilization of health care services, followed by migrants working in PSE, migrants working in IZ, and non-migrants. Health insurance is an important factor relating to the utilization. Accordingly, health insurance coverage needs to be increased if utilization of health care services for the whole population, particularly migrant population, is to be improved.

Sexual and reproductive health among unmarried rural-urban female migrants in Shanghai China: a comparative analysis

We compared sexual and reproductive health (SRH)-related knowledge, attitude and behavior among unmarried rural-urban female migrants in Shanghai coming from different regions of China. A total of 944 unmarried rural-urban female migrants were recruited from three districts of Shanghai. We used an interviewer-administered structured questionnaire to collect information from each participant and a multivariate logistic regression to examine the association between premarital sex and risk factors. We found the rates of premarital sex, pregnancy and abortion among unmarried rural-urban female migrants were 28.2%, 5.2% and 5.0%, respectively. Participants from the east of China were more likely to engage in premarital sex than those from the mid-west (p < 0.001). The analysis showed premarital sex was associated with age, hometown, education, current residential type, knowledge of sexual physiology and safe sex, attitude to SRH and safe sex, and permissive attitude to sex. Unmarried rural-urban female migrants lack SRH related knowledge and the data suggests high levels of occurrence of premarital sex. The results indicate that programs to promote safe sex, especially to those migrants coming from eastern China, should be a priority.