Provincial Survey Research Articles

Prevalence and Correlates of Sexting Behaviors in a Provincially Representative Sample of Adolescents.

To examine the prevalence and correlates of sending and receiving sexts (i.e., sexually explicit images) in a provincially representative sample of adolescents in Canada. Data from the 2014 Ontario Child Health Study, a provincial survey of households with children in Ontario, which includes a sample of 2,537 adolescents aged 14 to 17 years (mean age = 15.42, male = 51.6%) were used to address the research objectives. The past 12 months prevalence of sending and receiving sexts was 14.4% and 27.0%, respectively. In unadjusted logistic regression analyses, non-White adolescents and those living in low-income households were less likely to send or receive sexts compared to White and non-low-income adolescents. Adolescents who disclosed their sexual and/or gender minority identities were 3 to 4 times more likely to send and receive sexts than youth who had not disclosed these identities. Higher levels of mental health problems generally observed among adolescents who sent or received sexts. In fully adjusted models, low income and ethnic minority status were associated with reduced odds of sending and receiving sexts, while sexual and/or gender minority disclosure status was associated with increased odds. Social anxiety was associated with reduced odds of sending and receiving sexts, while conduct disorder was associated with elevated odds. The prevalence of sexting behavior was higher among adolescents who disclosed their sexual or gender minority identities. Sexting behaviors were associated with higher levels of mental health problems. Identifying vulnerable populations and the potential mental health ramifications associated with sexting behavior is vital to mitigating negative sequelae.

Effect of Eating Breakfast on Cognitive Development of Elementary and Middle School Students: An Empirical Study Using Large-Scale Provincial Survey Data.

BackgroundIn existing research on the importance of student breakfast, few studies have focused on the impact of breakfast on student cognitive development. Further, empirical research in this field is mostly based correlation analysis, in which it is difficult to control the influence of selection bias on the analysis results.Material/MethodsHere, we used student academic performance, based on the academic quality monitoring data of Jiangsu basic education students, as a proxy variable for cognitive development, and used both ordinary least-squares regression and propensity score matching methods to analyze the impact of eating breakfast on the cognitive development of primary and middle school students.ResultsWe found that it is still common for students in primary and secondary schools to go without breakfast, and that this is even true in middle schools. Whether students eat breakfast is affected by many factors, and the frequency of eating breakfast has a significant positive impact on student achievement.ConclusionsIn primary school, students who eat breakfast every day in a week scored 31.322 points higher in academic performance than those who did not. In middle school, students who ate breakfast on time every day had significantly better academic performance (31.335 points higher) than those who did not eat breakfast every day. This indicates that eating breakfast every day has a significant effect on the cognitive development of students.

Access to Primary Care and Internet Searches for Walk-In Clinics and Emergency Departments in Canada: Observational Study Using Google Trends and Population Health Survey Data.

BackgroundAccess to primary care is a challenge for many Canadians. Models of primary care vary widely among provinces, including arrangements for same-day and after-hours access. Use of walk-in clinics and emergency departments (EDs) may also vary, but data sources that allow comparison are limited.ObjectiveWe used Google Trends to examine the relative frequency of searches for walk-in clinics and EDs across provinces and over time in Canada. We correlated provincial relative search frequencies from Google Trends with survey responses about primary care access from the Commonwealth Fund’s 2016 International Health Policy Survey of Adults in 11 Countries and the 2016 Canadian Community Health Survey.MethodsWe developed search strategies to capture the range of terms used for walk-in clinics (eg, urgent care clinic and after-hours clinic) and EDs (eg, emergency room) across Canadian provinces. We used Google Trends to determine the frequencies of these terms relative to total search volume within each province from January 2011 to December 2018. We calculated correlation coefficients and 95% CIs between provincial Google Trends relative search frequencies and survey responses.ResultsRelative search frequency of walk-in clinic searches increased steadily, doubling in most provinces between 2011 and 2018. Relative frequency of walk-in clinic searches was highest in the western provinces of British Columbia, Alberta, Saskatchewan, and Manitoba. At the provincial level, higher walk-in clinic relative search frequency was strongly positively correlated with the percentage of survey respondents who reported being able to get same- or next-day appointments to see a doctor or a nurse and inversely correlated with the percentage of respondents who reported going to ED for a condition that they thought could have been treated by providers at usual place of care. Relative search frequency for walk-in clinics was also inversely correlated with the percentage of respondents who reported having a regular medical provider. ED relative search frequencies were more stable over time, and we did not observe statistically significant correlation with survey data.ConclusionsHigher relative search frequency for walk-in clinics was positively correlated with the ability to get a same- or next-day appointment and inversely correlated with ED use for conditions treatable in the patient’s regular place of care and also with having a regular medical provider. Findings suggest that patient use of Web-based tools to search for more convenient or accessible care through walk-in clinics is increasing over time. Further research is needed to validate Google Trends data with administrative information on service use.

The control of clonorchiasis in Guangdong province, southern China

Oriental liver fluke disease (clonorchiasis), caused by Clonorchis sinensis, is endemic in 81 counties in Guangdong province, China. This study was conducted following increasing lack of clonorchiasis awareness and increased consumption of raw freshwater fish and raw fish porridge at home and restaurants, which has been attributed to improved living standards in China, and is considered to have led to a higher C. sinensis infection rate in the country. A total of 61,517 individuals were investigated from 123 sites during a provincial survey in 1988, with average C. sinensis infection rate of 1.82% that increased to 4.08% (335/8217) in 1997. Higher infection rate was observed in adult men than women, with heavy infection rate in fishermen and businessmen because they have access and means to get raw fishes for consumption. Thus, clonorchiasis has become a serious public health problem in Guangdong province. Efforts targeting clonorchiasis prevention and control in Guangdong province started in the 1990s. These included carrying out large-scale surveys and chemotherapy in epidemic regions, research on promotion of environmental sanitation and methods for freshwater aquaculture. Establishment and promotion of clonorchiosis demonstration plots for comprehensive control measures, as well as the development of clonorchiasis-prevention community-out-patient clinics were initiated and their effectiveness was evaluated. However, there seem to be no obvious decline in the prevalence of C. sinensis with 4.90% (608/12,401) in 2015, at Guangdong province due to the people's habit of eating raw fishes in endemic areas. This has led to increasing calls to improve environmental sanitation in the aquaculture industry. It is, however, believed that control efforts on clonorchiosis in the province are at an early stage and require strengthening through the cooperation of different departments to work out effective strategies for sustainable field application of control mechanisms.

Implementing a one-day testing model improves timeliness of workup for patients with lung cancer.

Patients with lung cancer often experience stressful delays throughout the diagnostic phase of care. To address that situation, our multidisciplinary team created a "Navigation Day," during which patients partake in a single-day visit that comprises nurse-led teaching, social work, smoking cessation counselling, symptom control, and dedicated test slots for integrated positron-emission tomography and computed tomography (pet/ct), pulmonary function tests (pfts), and magnetic resonance imaging (mri) of the brain. We evaluated the effects of that program on wait times and patient satisfaction. Patients with a suspicion of lung cancer on chest ct imaging referred during 3 time periods were reviewed: 1 year before launch of the Navigation Day, 1 year post-launch, and 2 years post-launch. Patients were further stratified according to concordance of their test date with a Navigation Day date. Mean wait times for pet/ct, pfts, and mri brain were calculated for each group. Patient satisfaction was measured using a standardized provincial survey. The Student t-test and analysis of variance were used to assess for significance. After implementation, mean wait times in the first year improved to 9.2 days from 15.5 days for pet/ct (p < 0.0001), to 9.6 days from 15.7 days for pfts (p < 0.0001), and to 10.2 days from 16.0 days for mri brain (p < 0.0001). Patients who used a dedicated test slot experienced the shortest wait times, at 5.8 days for pet/ct, 5.8 days for pfts, and 6.3 days for mri brain (p < 0.0001). Those improvements were sustained at 2 years post-launch. Patient satisfaction in the categories of assistance, emotional support, and clarity remained high post-launch. Navigation Day significantly improved the timeliness of diagnostic testing services in patients with suspected lung cancer.

Arsenic and disinfection by-products (DBPs) in drinking water in Canada

OPS 25: Drinking water contamination and adult health, Room 411, Floor 4, August 26, 2019, 10:30 AM - 12:00 PM Introduction: People are exposed to Arsenic and DBPs (Trihalomethanes (THMs) and Haloacetic acids (HAAs) by drinking contaminated water. Arsenic is a naturally occurring element and known as a strong carcinogen. DBPs are formed by chlorination of water containing organic substances and considered possible human carcinogen. Water quality reports demonstrate the presence of high level of arsenic and DBPs in some areas of Newfoundland and Labrador (NL). However, there is no population level data on any association between the exposure to arsenic and DBPs and related cancer. Aim: To explore any association between Arsenic and DBPs present in drinking water and relevant cancers at the community level. Methods: High and low risk communities were identified based on water quality reports of provincial surveys. Cancer data were extracted from the NL Cancer Registry for cases diagnosed between 2007 and 2016. Certain disease information such as histology and topography and demographic information like sex, year of birth and residence at time of diagnosis were extracted. An ecological analysis was then conducted comparing cancer incidence rates between high risk and low risk communities. Results: Relative risk (RR) of arsenic induced cancers (a combination of renal cell, squamous cell of lung, skin, basal cell and Merkel cell of skin, adenocarcinoma of colon and bile ducts, hepatocellular and angiosarcoma of liver, cholangiocarcinoma, transitional cell carcinoma of urinary bladder) was 3.8 (95% CI, 1.09, 1.58). For DBPs, RR of THMs and HAAs induced cancer (a combination of urothelial cell carcinoma of urinary bladder, adenocarcinoma of rectum, colon and esophagus, malignant mesothelioma of lungs, and acute and chronic myeloid leukemia) was 2.1 (95% CI 0.67, 0.82). Discussion: Population level data showed that arsenic in drinking water was significantly associated in cancer incidences. However, despite the high relative risks, DBPs were not significantly associated with relevant cancer.

Factors influencing oral care in intubated intensive care patients.

The practice of oral care in intensive care settings remains inconsistent among intubated patients, yet these patients are at high risk of developing ventilator-associated pneumonia. Therefore, it is important to adopt safe professional behaviour based on clinical practice guidelines. This study was based on Ajzen's (1985) theory of planned behavior, a conceptual framework that allows a better understanding of how internal and external factors influence behaviour adoption. To study influential factors in how nurses practice oral care with intubated clients in intensive care settings, referring to the theory of planned behavior (TPB) constructs. A cross-sectional descriptive correlational design was conducted through a provincial postal survey in Quebec, Canada. A questionnaire was completed by 375 nurses working in intensive care units (ICUs). Perceived behavioural control and attitude were the most important determinants in the level of intention to engage in oral care. Knowledge, available human and material resources, and number of years of experience in critical care nursing also seemed to be significant influencing factors. This study improved our understanding of the factors influencing the practice of oral care in intubated patients in the ICU, relying on TPB as an explanatory framework. It would be important to continue to study this professional behaviour and to work in collaboration with health care facilities to promote the importance of oral care as an imperative for the safety and quality of health care. The results of this study represent a solid foundation for advancing continuing education programmes and intensive care orientation programmes tailored to the needs of nurses.

The development and reform of public health in China from 1949 to 2019

BackgroundPublic health system plays a vital role in the development of health sector in China and protects the health of Chinese people. However, there are few comprehensive reviews and studies focusing on its evolution and reform. It is worthwhile to pay attention to the public health development in China, given that the history and structure of public health system have their own characteristics in China.MethodsThe study is a retrospective review of the development public health over seven decades in China. It presents the findings from some national or provincial survey data, interviews with key informants, reviews of relevant published papers and policy contents.ResultsThis study identified four key stages that public health experienced in China: the initial stage centering on prevention, the stage of deviation with more attention to treatment but little to prevention, the recovery stage after SARS(Severe Acute Respiratory Syndromes) Crisis, and the new stage to an equitable and people-centered system. In the latest stage, the National Basic Public Health Service Program (NBPHSP) is implemented to respond the threat of noncommunicable diseases (NCDs) and has achieved some initial results, while there are still many challenges including service quality, poor integration among service items and IT system, lack of quality professionals and insufficient intersectoral endeavor.DiscussionThere are unique Chinese wisdom and remarkable achievements as well as twists and turns on the development of China’s public health. Prevention-first, flexible structure of the system, multi-agency collaboration and mass mobilization and society participation are the main experience of public health in early stage. Despite twists and turns since 1980s, public health system in China shows substantial resilience which may be from the government’s continuous commitment to social development and people’s livelihoods and its flexible governance. In 2010s, in order to achieve the well-off society, Chinese government pays unprecedented attention to health sector, which bring a new wave of opportunities to public health such as remaining the NBPHSP for priority. The evolution and reform of China’s public health is based on its national condition, accumulates rich experience but also faces many common worldwide challenges. Getting this development and reform right is important to China’s social and economic development in future, and China’s experience in public health may provide many lessons for other countries.ConclusionPublic health in China needs to focus on prevention, strengthen multi-agency coordination mechanism, improve the quality of public health services in the future.

Prevalence of Shiga toxin-producing Escherichia coli (STEC) O157:H7, Six non-O157 STECs, and Salmonella on beef carcasses in Provincially Licensed Abattoirs in Alberta, Canada

From January to December 2016, Alberta Agriculture and Forestry (AAF) conducted a provincial survey of selected pathogens and indicator organisms on beef carcasses processed at Provincially Licensed Abattoirs (PLAs) in Alberta. The survey was conducted in seven small and medium scale slaughterhouses located in southern and northern Alberta that process beef cattle and cows. Paired samples were collected from the same carcass immediately after hide removal (pre-evisceration n = 401) and at pre-chill (n = 402) after application of a carcass wash and/or anti-microbial interventions. Swab samples were screened for the presence of Shiga toxin-producing Escherichia coli (STEC) O157:H7, six non-O157 STECs (O26, O45, O103, O111, O121 and O145), and Salmonella. In addition, samples were enumerated for indicator organisms (aerobic colony count (ACC), Enterobacteriaceae, coliforms, and generic E. coli). At pre-evisceration, 30 samples (7.4%) were confirmed positive for E. coli O157:H7; 13 samples (3.2%) were confirmed positive for non-O157 STEC; and 7 samples (1.7%) were confirmed positive for Salmonella. Pre-chill swabs had 21 samples (5.2%) positive for E. coli O157:H7, 16 samples (3.9%) positive for non-O157 STEC, and 1 sample (0.2%) positive for Salmonella. At pre-chill the prevalence of Salmonella was significantly lower (P < 0.05) than at pre-evisceration. For ACC, Enterobacteriaceae, coliforms and generic E. coli log means were significantly lower at pre-chill than pre-evisceration (P < 0.05). The level of ACC, generic E. coli, coliforms and Enterobacteriaceae showed a reduction of 0.3 log CFU/cm2, 0.5 log CFU/cm2, 0.5 log CFU/cm2 and 0.4 log CFU/cm2 respectively.

Availability of palliative care services in Zambia: A nationwide provincial and tertiary hospital survey

BackgroundWith high rates of HIV/AIDS and rising burdens of non-communicable diseases, Zambians increasingly need palliative care. While efforts are underway to grow Zambia’s palliative care system, the most recent situational analysis of palliative care in Zambia, conducted in 2008, revealed substantial gaps in availability. MethodsTo provide an updated appraisal of breast and cervical cancer services in Zambia, including palliative care, we conducted a nationwide provincial and tertiary hospital survey. All 9 provincial hospitals and the University Teaching Hospital and Cancer Diseases Hospital in Lusaka Province participated (N = 11). The survey was conducted between August 2014 and January 2015 and administered in-person at each facility. Data regarding the availability of inpatient, outpatient, and community-based palliative care services, palliative medications, and psychosocial supports was obtained at each facility. The reported results are descriptive in nature. ResultsAlthough the need for palliative care services was recognized, many facilities (64%) lack palliative care policies and only 18% offer palliative care in a coordinated program. The majority of services are only available to inpatients and rarely include community-based programs. While all facilities had adequate supplies of acetaminophen, 82% reported unavailability of codeine and 45% reported no access to oral morphine. ConclusionsThis assessment confirms the dearth of palliative care services across Zambia. Less than half of its provincial hospitals offer community- or home-based services and only 55% offer opioid analgesics. Immediate and substantial improvements in policy, drug procurement and distribution, and service expansion are needed to ensure high-quality palliative care is available throughout Zambia.

Impact of Home-Based HIV Testing Services on Progress Toward the UNAIDS 90-90-90 Targets in a Hyperendemic Area of South Africa.

In several subgroups of South Africa, the percentage of HIV-positive individuals aware of their status falls well below the UNAIDS 90% target. This study examined the impact that home-based HIV testing services (HBHTS) had on knowledge of status in a hyperendemic area of South Africa. We analysed data from the second cross-sectional HIV Incidence Provincial Surveillance System survey (2015/2016), a representative sample (n = 10,236) of individuals aged 15-49 years. Participants completed a questionnaire, provided blood samples for laboratory testing (used to estimate HIV prevalence), and were offered HBHTS. The proportion of people living with HIV (n = 3870) made aware of their status through HBHTS was measured, and factors associated with HBHTS uptake were identified. Knowledge of HIV-positive status at the time of the survey was 62.9% among men and 73.4% among women. Through HBHTS, the percentage of HIV-positive men and women who knew their status rose to 74.2% and 80.5%, respectively. The largest impact was observed among youth (15-24 years). Knowledge of status increased from 36.6% to 59.3% and from 50.8% to 64.8% among young men and women, respectively. In addition, 51.4% of those who had previously never tested received their first test. Key reasons for declining HBHTS among undiagnosed HIV-positive individuals included fear and self-report of an HIV-negative status. HBHTS was effective in increasing awareness of HIV-positive status, particularly among youth, men, and those who had never tested. HBHTS could have a marked impact on progress toward the UNAIDS 90-90-90 targets within these subgroups.

Availability of palliative care services in Zambia: A nationwide provincial and tertiary hospital survey

Availability of palliative care services in Zambia: A nationwide provincial and tertiary hospital survey

Primary health care services for patients with chronic disease in Newfoundland and Labrador: a descriptive analysis.

Newfoundland and Labrador has a rapidly aging population, much of which is rural, with poor health behaviours and high rates of chronic disease. These factors contribute to a unique challenge in health care delivery. Our aim was to describe the availability of publicly funded primary health care programs and services delivered by regional health authorities across the province. We performed a descriptive analysis using data from a cross-sectional provincial primary health care survey deployed across Newfoundland and Labrador. Survey data included location, disease-specific chronic disease prevention programming, types of routine primary care, allied health prevention and promotion, chronic disease prevention and management services, and team-based care. The mode of service delivery was identified for most programs and services. Surveys were returned by 153 sites (99.4% response rate). Family physician services were available at 66% of sites (95/145) and nurse practitioner services were available at 51% (74/144) of sites. Many sites offered screening for cervical (60%, 86/144), colon (42%, 59/142) and prostate cancers (43%, 60/141), in addition to various self-management and education services. Allied health services, such as clinical nutrition counselling (47%, 68/46) and occupational therapy (46%, 68/147), were available at many sites. Available health care services were most often offered by on-site staff, and few sites provided primary health care services through telehealth. Overall, rural sites offered a greater variety of services than urban sites. Considerable variability exists in the range of primary health care services available across Newfoundland and Labrador, with limited delivery of some programs and services. Future research should examine how availability of programs and services affects health outcomes and costs.

Prevalence and associated factors of depression symptoms in fathers of children aged 6 months to 17 years in Québec

In fathers, depression symptoms experienced during pregnancy and after childbirth represent a depression risk factor during the child first months. Since depression can have a huge impact on their subsequent involvement with the child, this issue is worrisome and requires consideration. Until now, however, few studies have dealt with paternal depression and its determinants beyond the perinatal period. This study uses data from a representative provincial survey conducted with 1342 fathers of children aged 6 months to 17 years. It documents the prevalence of moderate and severe depression symptoms with the CES-D scale as well as associated factors. Findings show prevalence rates ranging from 3% to 10% depending on depression symptom severity and children age. Associated factors include problematic use of alcohol, no employment, stress related to balancing work and family, domestic violence environment, and low revenue and social support. These results are interpreted in light of the role and involvement fathers keep in their child's life. They also stress the importance of identifying depression symptoms in this population beyond the perinatal period while monitoring the symptom intensity.

Population-level sexual behaviours in adolescent girls before and after introduction of the human papillomavirus vaccine (2003-2013).

The human papillomavirus (HPV) vaccine is delivered widely through school-based immunization programs. Some groups have expressed concern that HPV vaccination programs will result in an increase in sexual risk-taking behaviours among adolescents. We aimed to evaluate population-level changes in sexual behaviours before and after implementation of the school-based HPV vaccination program in British Columbia. In 2008, a school-based HPV vaccination program for girls was introduced in British Columbia. Using data from the BC Adolescent Health Survey - a longitudinal provincial survey administered in schools to capture adolescent physical and emotional health indicators, we conducted a linear trend analysis on sexual health behaviours and risk factors in adolescent girls before and after the implementation of vaccination for HPV (2003, 2008 and 2013). We analyzed data for 298 265 girls who self-identified as heterosexual. The proportion of girls reporting ever having sexual intercourse decreased from 21.3% (2003) to 18.3% (2013; adjusted odds ratio [OR] 0.79). Self-report of sexual intercourse before the age of 14 years decreased significantly from 2008 to 2013 (adjusted OR 0.76), as did reported substance use before intercourse (adjusted OR for 2003-2013 0.69). There was no significant change in the number of sexual partners reported (2003-2013). Between 2003 and 2013, girls' reported use of contraception and condoms increased, while pregnancy rates decreased. Since the implementation of school-based HPV vaccination program in BC, sexual risk behaviours reported by adolescent girls either reduced or stayed the same. These findings contribute evidence against any association between HPV vaccination and risky sexual behaviours.

Provincial Survey of Supports for Students with Type 1 Diabetes at School

Provincial Survey of Supports for Students with Type 1 Diabetes at School

Assessment and determinants of per capita household CO2 emissions (PHCEs) based on capital city level in China

Household CO2 emissions were increasing due to rapid economic growth and different household lifestyle. We assessed per capita household CO2 emissions (PHCEs) based on different household consuming demands (including clothing, food, residence, transportation and service) by using provincial capital city level survey data in China. The results showed that: (1) there was a declining trend moving from eastward to westward as well as moving from northward to southward in the distribution of PHCEs. (2) PHCEs from residence demand were the largest which accounted for 44% of the total. (3) Correlation analysis and spatial analysis (Spatial Lag Model (SLM) and Spatial Error Model (SEM)) were used to evaluate the complex determinants of PHCEs. Per capita income (PI) and household size (HS) were analyzed as the key influencing factors. We concluded that PHCEs would increase by 0.2951% and decrease by 0.5114% for every 1% increase in PI and HS, respectively. According to the results, policy-makers should consider household consuming demand, income disparity and household size on the variations of PHCEs. The urgency was to improve technology and change household consuming lifestyle to reduce PHCEs.

Depression among the general adult population in Jiangsu Province of China: prevalence, associated factors and impacts

PurposeThis study aimed to assess the prevalence of depression and to investigate its associated factors and impacts on daily life functioning among the general adult population in Jiangsu Province of China.MethodsAs part of the Jiangsu Provincial Survey on Chronic Disease and Behavioural Risk Factors (2010), a sample of 8400 community residents aged ≥ 18 years were recruited. Study data were collected through a questionnaire-administered face-to-face interview. Depression was measured by the Patient Health Questionnaire.ResultsThe estimated prevalence of depression was 0.56% (0.54% in men and 0.58% in women). Increased risk of depression was found to be associated with rural residents (OR 2.24, 95% CI 1.33–3.78) and the comorbidity of chronic diseases (OR 3.83, 95% CI 1.33–11.02). Respondents with depression reported an average of 11.75 unhealthy days caused by physical illnesses and 8.31 unhealthy days by mood problems within the previous 30 days. Depression was also found to be related to worse self-ranked health status, worse relationships with families and lower life satisfaction.ConclusionsA low prevalence of depression was found in this population of China, though it is not clear the extent to which it reflects issues related to the measurement and/or other factors of the survey. Depression was found to be related to poorer health and poorer life functioning. Further research into the link between depression and access to mental health services in rural areas is necessary. Meanwhile, depression among chronic disease patients should be addressed in clinical settings, health plans and resources allocation.

An Overview of Coverage of BCG Vaccination and Its Determinants Based on Data from the Coverage Survey in Zhejiang Province.

To assess the Bacille Calmette-Guérin (BCG) vaccination coverage in Zhejiang province and to investigate predictors of the BCG vaccination, we used data from the 2017 Zhejiang provincial coverage survey. Demographic and immunization data on the selected children, their mothers, and their families were also collected by using a pre-tested questionnaire. BCG scars were verified among children who were available at the moment of survey. Coverage of BCG and other expanded program on immunization (EPI) vaccines scheduled before the first year of life was calculated. BCG coverage through the scar assessment and timeliness of BCG were also presented. Multivariate analyses of the predictors associated with the BCG vaccination and its timeliness were conducted separately. In total, 1393 children agreed to participate in the survey and presented the immunization cards. Of them, the coverage of BCG was 92.0% and 88.3% received the BCG within the first 28 days after birth. Besides this, 1282 out of the 1393 children were screened for the BCG scars and 97.1% of them had developed the scars. The multivariable logistic regression analyses indicated that hospital delivery, higher maternal education, a mother with no job, and a resident child were positively associated with the higher BCG vaccination coverage and its timely administrations. BCG coverage was optimal and it was administered in a timely manner. The majority of children vaccinated with BCG developed scars. Tailored interventions should be more greatly focused on and targeted to children with the risk factors identified in this study.

Epi Info Cloud Data Analytics to improve quality of HIV Surveillance in Vietnam.

Objective: To use Epi Info Cloud Data Analytics (ECDA) to improve the management, quality and utilization of the Vietnam National HIV Surveillance data.Introduction: HIV surveillance in Vietnam is comprised of different surveillance systems including the HIV sentinel surveillance (HSS). The HSS is an annual, multi-site survey to monitor HIV sero-prevalence and risk behaviors among key populations. In 2015, the Vietnam Administration on HIV/AIDS Control (VAAC) installed the Epi Info Cloud Data Analytics (ECDA), a free web-based analytical and visualization program developed by the Centers for Disease Control and Prevention (CDC)(1) to serve as an information management system for HIV surveillance. Until 2016, provincial surveys, recorded on paper, were computerized and submitted to VAAC, which was responsible for merging individual provincial datasets to form a national HSS dataset. Feedback on HSS issues were provided to provinces 3 to 6 months after survey conclusion. With the use of tablets for field data collection in 2017, provincial survey data were recorded electronically and transferred to VAAC at the end of each survey day, thus enabling instant updating of the national 2017 HSS dataset on daily basis. Upon availability of the national HSS dataset on VAAC’s server, ECDA enhanced wider access and prompt analysis for staff at all levels (figure 1). This abstract describes the use of ECDA, together with tablet-based data collection to improve management, quality and use of surveillance data.Methods: After the installation of the ECDA on VAAC’s server in 2015, investments were made at all levels of the surveillance systems to build the capacity to operate and maintain the ECDA. These included trainings on programming, administration, and utilization of ECDA at the central level; creating a centralized database through abstracting and linking different surveillance datasets; developing analysis templates to assist provincial-specific reports; and trainings on access and use of the ECDA to provincial staff. One hundred and eighty five ECDA analyst accounts, authorized for submission, viewing and analysis of data, were created for surveillance staff in 63 provinces and 7 agencies. Six administrator accounts, created for users at central and regional level, were authorized for editing data and management of user accounts. In 2017, more ECDA activities were conducted to: (i) develop analysis dashboards to track progress and data quality of HSS provincial surveys; (ii) facilitate frequent data reviews at central and regional levels; (iii) provide feedback to provinces on survey issues including sample selection.Results: Since 2015, separate national datasets including the HSS, HIV case reports, HIV routine program reports were systematically cleaned and merged to form a centralized national database, which was then centrally stored and regularly backed up. Access to the national database was granted to surveillance staff in all 63 provinces through 185 designated ECDA accounts. During the 2017 HSS surveys, 70 ECDA users in 20 HSS provinces were active to manage and use the HSS data. Twelve weekly reviews of HSS provincial data were conducted at national level throughout the 2017 HSS survey. Ninety percent of provinces received feedback on their survey data as early as the first week of field data collection. The national 2017 HSS dataset and its analysis were available immediately after the completion of the last provincial survey, which was about 3 to 6 months quicker than reports of previous years. More importantly, the fresh results of the 2017 HSS survey were available and used for the 2018 Vietnam HIV national planning circle (table 1).Conclusions: ECDA is a quick, relevant, free program to improve the management and analysis of HIV surveillance data. Using ECDA, it is easy to generate and modify analysis dashboards that enhances utilization of surveillance data. Successful administration and use of the ECDA during the 2017 HSS survey is positive evidence for Ministry of Health to consider institutionalization of the program in Vietnam surveillance systems.