Vietnam 2011

Community brochure

Clinic posterIn 2008, the Vietnamese Ministry of Health launched new national guidelines emphasizing the use of zinc and low-osmolarity ORS, along with proven tools like exclusive breastfeeding, hand-washing, and nutrition. Posters and leaflets at clinics and schools bring the message to families. A coordinated series of training workshops brought the new knowledge to health workers throughout the country.

ORS in the Nat'l Pediatric HospitalBuilding knowledge among mothers was a key strategy. First and foremost was greater emphasis on the use of low-osmolarity oral rehydration solution (ORS), particularly as a home-based treatment that can help avoid trips to the emergency room.

Learning about nutritionAs a mother administers ORS to her weakened infant, Dr. Luu My Thuc, head of the malnutrition unit at the National Pediatric Hospital, advises her on proper nutrition to prevent diarrhea as well as continued feeding during diarrheal episodes.

Mothers bond while infants healDuring the slow process of sip-by-sip rehydration, mothers bond in the inpatient pediatric ward.

Dr. Hai and a patientDr. Le Thanh Hai, vice director of NPH, led the update of national clinical guidelines, a key component of which is educating caregivers while they are in the clinical setting. Here, he discusses the importance of proper nutrition and hygiene with a mother on the pediatric ward.

Administering ORS

Recovering in the pediatric ward

Well enough to play!A colorful playground on the National Pediatric Hospital campus provides welcome distraction for recovering children, their siblings, and parents.

Coastal Binh DinhHeading out from Hanoi, we visited Binh Dinh—a province on the eastern coast that hosted a demonstration project to put the new clinical guidelines into practice. From the looks of the landscape, this was not too shabby for a field assignment!

"Moonlight" in the afternoonDowntime while we waited for our ride further into the province revealed a colleague’s hidden talent: Dr. Huong Minh Vu, leader of PATH’s Enhanced Diarrheal Disease Control Program in Vietnam, treated us to a few bars of Beethoven’s Moonlight Sonata.

Lush landscape of Binh Dinh

ORT corner in Binh Dinh HospitalRevitalization of ORT corners was another major component of the update to diarrhea programs in Vietnam. Supplies and clean water are available at the ORT corner in the pediatric unit of Binh Dinh Provincial Hospital.

ORT educational sessionTwice each week, nursing staff gather parents from throughout the hospital—not limited to just those parents with children suffering from diarrhea—for an educational session at the ORT corner.

Educational brochure for parentsParents are provided brochures they can bring home, with guidance on how to feed an infant suffering from diarrhea, preparation and administration of ORS and zinc at home, and recognizing the symptoms of severe dehydration that may call for urgent clinical intervention .

Perusing the important content?

Educational posters in the pediatric wardHelpful posters throughout the pediatric unit detail appropriate prevention measures, like handwashing, clean water, and safe food preparation.

Mixing ORSNurse Nguyen Thi Huong employs a volunteer to demonstrate the preparation of ORS, which mothers can provide to children at home to stave off severe dehydration.

Anh Thu on the road to recoveryAnh Thu, 22 months old, is recovering from a severe diarrhea infection. After two days of vomiting, watery stools, and a fever, her mother brought Thu to the provincial hospital for urgent treatment. They had been at the hospital for two days and after a regimen of zinc and low-osmolarity ORS, Anh’s condition improved. They were heading home tomorrow.

Zinc tabletsThrough the new guidelines, zinc is now a staple of diarrhea treatment in Binh Dinh. Parents and physicians alike were pleased to note that children love the taste and that it also stimulates weakened appetites.

Dissolving the zinc doseDr. Le Quang Hung, deputy director of the Binh Dinh Department of Health, demonstrates the proper administration of zinc… little did I know the large pill was meant to be dissolved rather than swallowed whole!

Clinical examination for severe dehydrationDr. Nguyen Khanh Toan, head of pediatrics at Binh Dinh hospital, examines a young inpatient for signs of dehydration.

Pediatric inpatients at Binh Dinh HospitalBefore the new guidelines launched in 2008, the entire pediatric ward at Binh Dinh Provincial Hospital was often filled with inpatients undergoing treatment for severe diarrhea. Today, diarrhea patients fill two rooms at the most. Hospital staff see far fewer mild cases, too—which they attribute to better household treatment and improved knowledge among community health centers.

Hoai Nhon commune health clinicA commune health center in the Hoai Nhon district of Binh Dinh.

ORT at Hoai NhonThe ORT corner at the commune health center.

Routine case reportingResources from the PATH project support routine monthly case reporting to the district hospital, through a standard form shown here at the commune health center.

Sharp drop in monthly diarrhea casesA bar graph of pediatric diarrheal disease cases by month at the commune clinic records a sharp decline during early months of 2011, which would typically comprise the high season for rotavirus, the most common cause of severe diarrhea in children.

Closing ceremony for PATH projectNational, provincial, and local officials joined local pharma producer Bidiphar and the Pasteur Institute for a commemorative close-out of the PATH project. Among the project’s achievements, presenters highlighted increased knowledge among mothers about use of the new ORS and zinc for home-based care.

Vice Chairwoman of the Binh Dinh People's CommitteeVice Chairwoman Nguyen Van Cang of the People’s Committee of Binh Dinh was a distinguished speaker at the closing workshop. She praised the “success of the design, planning, and close cooperation” of project partners.

Pursuing partnershipsWhile PATH’s project has come to a close, important partnerships will persist. Dr. Hai of NPH, Vien Quang Mai of the Nha Trang Pasteur Institute, and Do Si Hien of the Center for Research and Consultancy on Community Health discuss the project’s achievements, challenges and their role in informing a long-term plan for sustainability and nationwide expansion.