Integrated nutrition programs are widely used to prevent and/or reverse childhood malnutrition, but rarely rigorously evaluated. The impact of such a program on the physical growth of young rural Vietnamese children was measured. We randomized six communes to receive an integrated nutrition program implemented by Save the Children. We matched six communes to serve as controls. Our sample consisted of 238 children (n = 119 per group) who were 5 to 30 months old on entry. Between December 1999 and December 2000, we measured weight and height monthly for six months and again at month 12. Principle outcomes were weight-forage Z score (WAZ), height-forage Z score (HAZ), and weight-for-height Z score (WHZ), and the changes among these measures. As expected, anthropometric indicators relative to international references worsened as the children aged. Overall, children in the intervention communes who were exposed to the integrated nutrition program did not show statistically significant better growth than comparison children. Intervention children who were younger (15 months or less) and more malnourished (less than-2 Z) at baseline, however, deteriorated significantly less than their comparable counterparts. Between baseline and month four, for example, intervention children who were malnourished and less than 15 months old at entry lost on average 0.05 WAZ while similar comparison children lost 0.25 WAZ (p = .02). Lack of overall impact on growth may be due to a lower than expected prevalence of malnutrition at baseline and/or deworming of comparison children. Targeting nutrition interventions at very young children will have the maximum impact on growth.

In 2006, typhoon Xangsane disrupted a multi-agency health needs study of 4,982 individuals in Vietnam. Following this disaster, 798 of the original participants were re-interviewed to determine NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript prevalence and risk-factors associated with post-traumatic stress disorder (PTSD), major depressive disorder (MDD), panic disorder (PD), and generalized anxiety disorder (GAD) according to the DSM-IV (APA, 1994). Post-typhoon prevalences were: PTSD 2.6%; MDD 5.9%; PD 9.3%; GAD 2.2%. Of those meeting criteria for a disorder, 70% reported only one disorder, 15% had two, 14% had three, and 1% met criteria for all four disorders. Risk factors for post-typhoon psychopathology differed among disorders, but generally were related to high typhoon exposure, prior trauma exposure, and in contrast to Western populations, higher age, but not gender. Keywords DISASTER; TYPHOON; PTSD; DEPRESSION; PANIC; VIETNAMHurricanes striking the coast of the United States significantly affected both physical infrastructure and health in the past five years, and questions have been raised regarding the mental health effects of such events (Acierno, Ruggiero, Galea et al., 2007;Acierno, Ruggiero, Resnick et al., 2006;Galea, Brewin, Jones, et al., 2007; Kahn, Mackert & Johnson, 2007;Rhoads, Pearman, Rick, 2007;Weems, Watts, Marsee, 2007;Weisler, Barbee & Townsend, 2006). As expected, hurricane researchers replicated previous findings of increased prevalence of negative mental health outcomes secondary to other natural disasters (Briere & Elliot, 2000;Galea et al., 2007;Norris, 2005;Norris Friedman & Watson, 2002a;Norris, Friedman, Watson et al., 2002b;Sajid, 2007), including posttraumatic stress disorder [PTSD], major depressive disorder [MDD], generalized anxiety disorder [GAD], panic disorder [PD], and substance use disorders. Moreover, specific risk factors for these negative outcomes were identified, including pre-hurricane exposure to potentially traumatic events (PTEs), high fear levels during the hurricane itself, lower age, and low social support (Acierno et al., 2007).Most post-disaster research has been on Western populations, and relatively little research exists on mental health effects of disasters on diverse populations outside of the United States (Norris et al., 2002b), particularly in lower or middle income countries, with less well developed mental health infrastructures such as that in Vietnam. However, recent efforts by the Vietnamese government to conduct mental health needs analyses, specifically the Da Nang Department of Health and the Khanh Hoa Health Service serendipitously allowed us to begin to address this deficit. During one of these needs analyses, on October 26 th , 2006 typhoon Xangsane, equivalent to a Category 4 hurricane, struck Vietnam. Despite an extraordinarily successful evacuation, Xangsane was responsible for at least 72 deaths, hundreds of severe injuries, and at least $629 million in damages in Vietnam (Iglesias, 2006; Chaudh...

Beverley-Anne Biggs and colleagues conduct a community-based cluster randomized trial in rural Viet Nam to compare the effect of antenatal iron-folic acid supplementation taken daily or twice weekly on maternal and infant outcomes. Please see later in the article for the Editors' Summary

ObjectiveVitamin D deficiency affects 1 billion people globally. It has an important role in bone homeostasis, brain development and modulation of the immune system and yet the impact of antenatal vitamin D deficiency on infant outcomes is poorly understood. We assessed the association of 25- hydroxyvitamin D levels (25-OHD) in late pregnancy and early infant growth and developmental outcomes in rural Vietnam.Design and MethodsA prospective cohort study of 960 women who had previously participated in a double-blind cluster randomized controlled trial of antenatal micronutrient supplementation in rural Vietnam was undertaken. Maternal 25-OHD concentration was measured at 32 weeks gestation, and infants were followed until 6 months of age. Main outcome measures were cognitive, motor, socio-emotional and language scores using the Bayley Scales of Infant Development, 3rd edition, and infant length-for-age z scores at 6 months of age.Results60% (582/960) of women had 25-OHD levels <75 nmol/L at 32 weeks gestation. Infants born to women with 25-OHD deficiency (<37.5 nmol/L) had reduced developmental language scores compared to those born to women who were vitamin D replete (≥75 nmol/L) (Mean Difference (MD) −3.48, 95% Confidence Interval (CI) −5.67 to −1.28). For every 25 nmol increase in 25-OHD concentration in late pregnancy, infant length-for-age z scores at 6 months of age decreased by 0.08 (95% CI −0.15 to −0.02).ConclusionsLow maternal 25- hydroxyvitamin D levels during late pregnancy are of concern in rural Vietnam, and are associated with reduced language developmental outcomes at 6 months of age. Our findings strengthen the evidence for giving vitamin D supplementation during pregnancy.

BackgroundAcute respiratory infections and diarrhea remain the leading causes of infant morbidity and mortality, with a high burden of both pneunomia and diarrhea in South-East Asia. The aim of the study was to determine antenatal and early infant predictive factors for severe morbidity episodes during the first 6 months of life in Ha Nam province, Vietnam.MethodsA prospective cohort study of 1049 infants, born to women who had previously participated in a cluster randomized controlled trial of antenatal micronutrient supplementation in rural Vietnam, was undertaken between 28th September 2010 and 8th Jan 2012. Infants were followed until 6 months of age, and the outcome measure was inpatient admission for suspected pneumonia or diarrheal illness during the first 6 months of life. Risk factors were assessed using univariable logistic regression and multiple logistic regression.ResultsOf the 1049 infants seen at 6 months of age, 8.8 % required inpatient admission for suspected pneumonia and 4 % of infants required inpatient admission for diarrheal illness. One third of infants (32.8 %) were exclusively breast fed at 6 weeks of age. Exclusive breast feeding at 6 weeks of age significantly reduced the odds of inpatient admission for suspected pneumomia (Odds Ratio (OR) 0.39, 95 % Confidence Interval (CI) 0.20 to 0.75) and diarrheal illness (OR 0.37, 95 % CI 0.15 to 0.88).ConclusionsExclusive breast feeding in early infancy reduces the risk of severe illness from diarrhea and suspected pneumonia. Public health programs to reduce the burden of inpatient admission from diarrheal and respiratory illness in rural Vietnam should address barriers to exclusive breast feeding.