Objective: To identify if the nutritional status and improvements in Vietnam during the 1990s applied equally to the key vulnerable population groups (poor, rural, and ethnic minority) as it did to the nonpoorFlargely in the urban areas. Design: This study used cross-sectional analyses in the context of inequalities occurring in the diets of the poor and nonpoor that accompanied economic improvements during the Vietnam Doi Moi period. Setting: During the Doi Moi period in Vietnam. Subjects: A cross-sectional analysis was conducted on data using 23 839 individuals (4800 households) from the Vietnam Living Standard Survey (VLSS) in 1992-1993 and 28 509 individuals (6002 households) from the Vietnam Living Standard Survey in 1997-1998. Analysis for changes in food consumption was conducted on 17 763 individuals (4305 households) that were included in both surveys. Intervention: None. Results: After initiation of Doi Moi in 1986, the average Vietnamese person reached the dietary adequacy of 2100 kcal per day per capita in the early 1990s, but this did not improve during the next decade. The structure of diet shifted to less starchy staples while proteins and lipids (meat, fish, other protein-rich higher fat foods) increased significantly. Although the gap in nutrient intake between the poor and the nonpoor decreased, the proportion of calories from protein-and lipid-rich food for the poor is lower than for the nonpoor. The VLSS data showed that the increase of protein and lipid foods in total energy structure over the 5 y between the VLSS studies for poor households was 0.43% (CI ¼ 0.33, 0.53) and 0.47% (CI ¼ 0.41, 0.54) lower, respectively, than for nonpoor households (Po0.0001). Inequalities compared to the nonpoor were also found in both quantity and quality of food consumption. For example, poor households consumed (quantity) 127 kcal/day (CI ¼ 119, 135) less from meat, and 32 kcal/ day (CI ¼ 27, 38) less from fats than nonpoor households (Po0.0001), and the proportion of calories consumed (quality) by poor households was 5.8% (CI ¼ 5.4, 6.1) less from meat and 0.96% (CI ¼ 1.2, 0.7) less from fats than by nonpoor households (Po0.0001). Conclusions: Although the key vulnerable groupsFrural, poor, and minority populationsFshowed improvements in diet, there still remains an inequity between these groups and the nonpoor of the population. In particular, the vulnerable groups consumed less of their daily consumption from the desirable high-quality proteins of animal foods and fats, and more from cereals and other starchesFlagging the better-off populations in desired composition.

Children of rural households, poor households, and ethnic minority backgrounds are significantly more likely to be malnourished than urban residents, children of nonpoor households, and the majority Kinh population. Additionally, avenues to escape malnourishment are limited in the former categories. These results suggest that economic improvements in Vietnam have, for the most part, bypassed the rural poor and minorities, and targeting economic resources towards these groups will be most critical to reduce malnutrition in Vietnam.

Selected determinants of overall infant mortality in Vietnam were examined using data from the 1988 Vietnam Demographic and Health Survey, and factors underlying neonatal and post-neonatal mortality were also compared. Effects of community development characteristics, including health care, were studied by logistic regression analysis in a subsample of rural children from the 1990 Vietnam Accessibility of Contraceptives Survey.Infant neonatal and post-neonatal mortality rates showed comparable distributions by birth order, maternal age, pregnancy intervals, mother's education and urban-rural residence. Rates were highest among first order births, births after an interval of less than 12 months, births to illiterate mothers and to those aged under 21 or over 35 years of age. Logistic regression analysis showed that the most significant predictor of infant mortality was residence in a province where overall infant mortality was over 40 per 1000 live births. In the rural subsample, availability of public transport was the most persistent community development predictor of infant mortality. Reasons for the low infant mortality rates in Vietnam compared to countries with similar levels of economic development are discussed.

This paper addresses the overall performance and inequalities in the immunization of children in Vietnam. Descriptive and logistic analysis of cross-national demographic and health data was used to examine inequality in immunization, identify the most vulnerable groups in immunization coverage, and identify the gap in coverage between hard-to-access people and the remainder of the population. The gap in the coverage was found to occur primarily in vulnerable groups such as the poor minority or poor rural children. No evidence was found of a difference in immunization coverage because of sex or birth order. However, the age of children showed a significant influence on the rate of immunization. Mother's education and regular watching of television had a significant influence on child immunization. In order to improve child immunization coverage in Vietnam, efforts should be concentrated on poor children from minority groups and those living in rural areas, especially remote ones. Community development, investment for immunization and re-organization of immunization services at the grassroots level are also key factors to remove the barriers to immunization for vulnerable populations in Vietnam.

CONTEXT: Accessibility of contraceptives is an important factor in use of family planning. Because contraceptive access in Vietnam varies sizably by region and because one method (the IUD) predominates in Vietnam's contraceptive method mix, a better understanding of the accessibility of family planning services in the country could help program planners increase use. METHODS: Data from the 1997 Vietnam Demographic and Health Survey on 5,310 currently married women of reproductive age were used to examine factors related to the accessibility of family planning services. The effects of individual-level and community-level factors were analyzed jointly.RESULTS: Nearly 84% of currently married Vietnamese women-100% of those in urban areas and 80% of those in rural areas-lived within one kilometer of least one source of family planning services in 1997. Commune health clinics and drugstores were the major providers, with 55% and 47%, respectively, of women located within one kilometer of such sources; these were followed by community health and family planning workers (40% and 27%). A multiple regression analysis showed that ready access to any source of family planning significantly reduced nonuse of modern methods (odds ratio, 0.6) and current use of traditional methods (0.6). Likewise, access to a greater number of sources of family planning reduced nonuse of modern methods (0.9) and current use of traditional methods (0.9). CONCLUSION: Increased availability of contraceptive methods and information could increase use of family planning in Vietnam. International Family Planning Perspectives,