Summary
ASSESSING EXPOSURE RISK AND HEALTH CONDITION OF PEOPLE LIVING NEAR DIOXIN - CONTAMINATED AREAS IN DA NANG
The military operation spraying Agent Orange/DJoxin done by the US Army was ended in 1 9 7 1 . After 40 years, dioxin concentration in areas sprayed by AO/DJoxin has reduced to background levels or not detected. However, in some US former airbases, dioxin concentration is still remained at elevated and very high levels, especially those in Da Nang and Bien Hoa airbases. Objectives: (DAssessing ability to control dioxin contamination in living areas near by "hotspots"; (2)Assessing efficiency of awareness raising solutions in order to reduce dioxin exposure risk df ccmmunJties living near "hotspots". Conclusion:
Despite of number of applied methodologies on institution, awareness raising, health examination and iJvelJheod support for pedple living near AO/DiexJn contaminated areas, we haven't comprehensively controlled sources of dioxin exposure as well as people with high risk to dioxin exposure. It may be necessary to change methoddldgies fer infdrmJng and raising awareness on adverse effects of AO/DJoxin in
"hotspots" toward more specifically, more clearly, more understandable and impressive so that cultivating, harvesting and consuming products from dioxin - contaminated ponds w i l l be completely stopped
Keywords: AO/Dioxin exposure, public health
MO HINH OM DAU VA HANH VI sD DUNG DjCH VU Y TE CUA NGUCJl DAN TAI HUYEN BA VL HA NOI NAM 2008
• • r »
Nguyen Phuong H o a \ Pham Van Thao^
'Trddng Dai hoc Y Ha Ndi; 'Hoc vien Qudn Y
Thdng hn vi tinh trang dm dau vd sd dyng dich vy y ti cua ngddi dan cd y nghia quan trgng trong viec cung cap cdc bdng chdng di xdy ddng ki hoach chdm sdc sdc khde. Muc tieu: md td vd phan tich tinh hinh dm dau, sd dyng dich vu y te cua ngddi dan tai huyen Ba Vi, Hd Ngi. Dd'i tugng va phuang phap nghien cdu: nghien cdu ddde tien hdnh tai cd sd thdc dia dich ti hgc Ba Vi nam 2008 theo thiet ke nghien cdu nw ta. Ket qua va ket luan: ty le ngddi ddn khai bdo cd dm dau Id 56,5%, ty le ndy d nd cao han d nam gidi.
Ho, dau ddu, sdt va dau khdp Id cdc tneu chdng/benh phd biin. Cdc nhdm tudi khac nhau cd md hinh benh/trieu chdng khde nhau. Ngddi ddn thddng Ida chon khdm ehda benh tai cdc ca sd y ti td nhan (34,3%), hieu thudc (31,6%) va td diiu tri (23,4%). Cdc yeu td kinh te - xd hdi cd dnh hddng tdi viec Ida chon loai hinh dich vu y te.
Tii khoa: tU khai bao dm dau, trieu chdng, sd dung djeh vu y te'
I. D A T V A N D E each d l y du. Thdng tin v l benh tat vd td vong 0 cdc nddc dang phdt trien, thdng tin ve sdc ehu yeu dda tren sd lieu td cae eo sd y te edng, khde va y t l ehda ddde thu thap va bao eao mpt edn thieu thdng tin td edng ddng. Tuy nhien, ede
so lieu v l tinh trang dm dau, benh tdt vd sd dung djch vu y te cua cdng ddng ed y nghia rat quan trpng trong viee gdp phan md td sdc khde ddng thdi phdn dnh nhu c l u v l chain sdc sdc khde cua ngddi dan.
Trong nhOng nam qua d Viet Nam, ddi sdng vd sdc khde eua nhan ddn da ddde e l i thien rd ret.
Nhd sd phdt trien eua n i n kinh te vd hieu q u i eua mpt sd ehUdng trinh y te dd phdng, ddc biet Id chddng trinh tiem ehung md rdng, vi vdy ty le m i e vd td vong do mpt sd benh n h i i m trung dd giam dang ke. Viet Nam dang trong thdi ky chuyen ddi djeh t l hpe - chuyen ddi td md hinh m i c ede benh lay n h i i m phd bie'n sang md hinh ed n h i l u benh khdng lay nhiem [1].
Td nam 1986 - bat dau thdi ky "ddi m d i " , co ehe tdi chinh y te d Viet Nam da cd n h i l u thay ddi, ed sd chia se kinh phi khdm ehda benh gida Nhd nude va tdng ea nhan trong xa hpi. Cdc ed sd y, ddde td nhan ddpc khuyen khich phdt t r i l n vd tham gia vdc mang Iddj cung cap cdc djch vu y te. Qud trinh ddi mdi dd thue day cdng tdc xd hpi hda y te, gdp p h i n ndng cao chat Iddng eac djch vu y te. Tuy nhien, viec Ida chpn sd dung djeh vu y te cua ngddi ddn phu thupc vao rat n h i l u yeu td nhu: Cd sd ha t i n g , dja ly, van hda, kha nang chi tra, mdc dp benh tat, cha't Iddng eua ede ed sd y te, ... Mpt sd k i t q u i nghien edu trdde ddy cho tha'y ty le td khai bdo dm dau cua ngddi ddn ndi ehung la 48% 15] vd d ngddi cao tudi la 5 2 % [7]. Ket q u i nghien cdu eua Nguyin Duy Khe va edng sd dd eho tha'y khi ngddi ddn bj dm thddng Ida chpn hinh thdc td d i l u trj, tiep theo la cd sd y te td nhdn.
Tram Y t l xd vd benh vien ddde Ida chpn it hdn.
Dilu kien kinh te eua he gia dinh cd lien quan den sd Ida chpn loai hinh djeh vu y te [5].
Viee theo ddi tinh hinh sdc khde cua cpng ddng ed y nghTa quan trpng, n h i m eung cap cdc b i n g chdng c i n thie't gidp cho viec xdy ddng ke hcach vd hoach djnh chinh sdeh y te.
Chung tdi tien hdnh nghien cdu ndy tai huyen Ba Vi, Ha Ndi vdi muc tieu:
/. Md ta tinh hinh dm dau theo khai bao cua ngudi dan huyen Ba Vi trong nam 2008.
2. Phan tich md hinh sd dung dich vu y te cua ngUdi dan khi dm dau tai huyen Ba Vi.
II. DOI Tl/ONG vA PHUONG
PHAPNGHIEN CL/U
1. Dja diem nghien cu'u: nghien edu ddde tie'n hdnh tai ed sd thdc dja djch t l hpc FilaBavi thupc huyen Ba Vi, Hd Npi.
2. Ddi tUOng nghien cii'u: ngddi dan thudc mpj Ida tudi d c l hai gidi tai ed sd FilaBavi.
3. Chpn mau va cd m i u : huyen Ba Vi cd 32 xd. Ddn sd todn huyen khoang 262.000 ngddi.
Ddn vj chpn m i u la ldng, met sd Idng ldn ddde tach ra de phue vu eho edng tae chpn mau. Toan bp huyen Ba Vi ddpc chia thdnh 352 cum. Ap dung phddng phdp chpn m i u nhieu bddc, ke't hdp phdn t i n g theo tfnh chd't dja ly (khu vdc mien ndi, vung gd ddi, ddng b i n g va ven sdng); trong tdng tang dja ly xdc suat eua cdc cum ddde chpn vao mau nghien edu ty le vdi sd Idpng dan ed cua cum dd (phddng phdp chpn m i u PPS). 71 cum da ddde chon vdi sd dan khoang 50.000 ngddi, sdng trong 1 1.089 hd gia dinh. Td't ca eac thdnh vien trong hp gia dinh thudc nhdng cum da ddde chpn vdo nghien cdu d i u dupe d i l u tra thu thdp thdng t i n . , Sd dan thudc mau d i l u tra chie'm khoing 2 0 % tdng so dan eua toan huyen Ba Vi.
4. Thu thap sd lieu: nghien edu bao gdm 4 cude dieu tra hd gia dinh trong 12 thdng eua nam 2008. Cd 3 thdng mdt lan (hang quy) se cd d i l u tra vien de'n tdng hp gia dinh d l phdng vd'n trdc tiep b i n g bd cdu hdi. Cdc thdng tin v l dm dau, benh tdt vd sd dung djeh vu y te trong vdng 4 t u i n trdde ngay phdng van se ddde thu thap. Cde d i l u tra vien ddde tap hud'n can than de tien hdnh
phdng van thu thdp thong tin, trdnh bd sdt sd kien. Hdi thao rut kinh nghiem viec thu thap sd lieu vd tap hud'n lai ddde td chdc d i u dan cudi mdi thang. De d i m bao tinh chinh xac vd dp tin eay eua sd lieu thu ddoc, ed sd thdc dia djch te hpc FilaBavi dd xay ddng quy trinh gidm sat vdi n h i l u cap dd khde nhau. Gidm sat vien thdc dja phdng van lai ngdu nhien 5% sd hd gia d i n h . Cae nghien cdu vien thdc hien viec gidm sat thu thap thdng tin tai thdc dja, k i l m tra thdng tin eua ede phieu phdng van da hodn thanh.
5. Phan tich sd lieu: nghien cdu sd dung p h i n m i n Access 2000 d l nhdp sd lieu, phan tich sd lieu b i n g phan men Stata phien ban 10.0. Cdc thuat todn khi binh phUdng (x'), t - test dUdc sd dung nham so sdnh sd khde biet gida ede nhdm.
Phdn tich da bien vdi md hinh hdi quy logistic ddde sd dung de ddnh gia mdi lien quan gida tinh trang dm dau, md hinh sd dung djeh vu y te vdi mdt sd ye'u td kinh te - xa hdi. Nghien cdu sd dung mde y nghTa a = 0,05 vd k h o i n g tin eay la 95%.
III. KETQuA
1 . M6 hinh tU khai bao dm dau
Tdng sd ed 49.541 ngddi dan tai eo sd thdc dja djch te hpe FilaBavi ddpc d i l u tra (23.994 nam gidi va 25.547 nd gidi). 55,5% trong sd ho khai bdo bj dm it nhdt mpt lan vdo k h o i n g thdi gian 4 tuan trddc thdi diem phdng van. K i t q u i nghien cdu eho tha'y nd gidi ed ty le bj dm eao hdn d nam gidi ( 6 2 , 1 % va 50,6%; p < 0,01). Trung binh ed 1,2 l l n dm tren mpt ngddi dan.
Bang 1. So ngUdi vd so lugt khai bao dm dau theo nhdm tudi tai Ba Vi.
Nhom tudi 0 - 4 tudi (n = 4 1 7 0 ) 5 - 1 4 tudi (n = 8065) 1 5 - 5 9 tudi (n = 31459)
> 60 tudi (n = 5837)
Sd ngddi ed sU kien dm Trung binh sd Idot dm Sd ngddi cd sd kien dm Trung binh so Idot dm Sd ngddj cd sd kien dm Trung binh sd Iddt dm So ngddi cd sd kien dm Trung binh sd lUdt d'm
Nam 1874 2,0 2464
1,0 5097
0,7 1705
1,9
NO 1585
1,9 2262
1,0 8814
1,1 3194
2,5
Tdng
3459 2,0 4726
1,0 14911
0,9 4899
2,2
p*
0,133
0,689
0,000
0,000 Nhan xet bang I: * So sdnh hai gid tri trung binh sd Idat dm gida nam vd nd
Ty Ic; khai bao dm dau d nhdm ngtfdi Id can bo vien chdc nha nddc (trung binh 0,7 lan) tha'p han d nhdm ngddi lam rudng (tning binh 1,5 lan), (p < 0,01).
Kit qua nghien cdu cho thay bdn trieu chdng phd bien nha't la ho (32,1%), dau dau (26,3%), sdt (23,4%) va dau khdp (11,5%). Ty le nd gidi mdc cdc trieu chdng/benh nay cao han a nam gidi.
Nhdn xet bang 2: * % tinh tren sd ngtfdi theo ddi ddac d FilaBavi. Mdt ngddi cd the bi mdc nhiiu trieu chdng/benh trong nam 2008.
Ket qua nghien cdu cung chi ra rdng a cac nhdm tudi khde nhau thi md hinh benh/trieu chdng cung thay ddi. O nhdm ngddi cao tudi (tudi > 60), cdc trieu chdng phd bien nhat Id dau dau (53,0%), dau khdp (43,4%), ho (39,0%), va sdt (21,4%). 6 nhdm tre em td 0 - < 5 tudi hai trieu chdng hay gap nha't
la ho (73,9%) vd sd't (67,4%o).
Ket qua phdn tich da bien cho thay cdc ye'u td gidl, nghi nghiep vd tnnh do van hda cd lien quan den viec mdc cdc benh/trieu chdng khde nhau. Nghien cdu cung cho thay, ty le bi tai nan thtfang tich d nam gidl cao han a nd gidi, (OR=l,44; 95% Cl: 1,28 - 1,63). Nhdm ngddl lain nghe ndng cd ty le mdc cdc trieu chdng ho, sd't, dau dau vd dau khdp cao ban d nhdng ngddi Id cdng chdc va lam cdc nghe khde (p <
0,05). Vdi nhCfng ngtfdi cd tnnh do hoc thd'p han tieu hgc (cap I), ty le bi mdc cdc trieu chdng ho, sdt, dau khdp va tai nan cao han a nhdm ngddl cd tnnh do hgc van cao han (# tieu hoc), (p < 0,05).
Bang 2. Ty le mac mgt so benh/trieu chdng theo gidi tai Ba Vi, nam 2008
Ho Dau d i u Sdt Dau khdp Dau da d Benh tim
Cac van de
dy/thddng vi mach (tang Tai nan, thddng tich
sOc
HA khde
dau ngUe,...)
Nam (23994) n 7311 4378 5494 1786 775 512 508
( % ) •
(30,5) (18,2) (22,9) (7,4) (3,2) (2,6) (2,5)
NU (25547) n 8581 8655 6106 3895 804 794 464
( % ) •
(33,5) (33,9) (23,9) (15,2) (3,1) (3,1) (1,8)
P
0,000 0,000 0,008 0,000 0,600 0,000 0,000 2. Sii' dung djch vu y te
23,4% ngUdi dan Ida chpn phddng thdc td d i l u trj khi bj dm, ty le nay d nO gidi eao hdn nam gidi (26,2% va 19,3%; p < 0,001). Nhin ehung, ngddi dan d huyen Ba Vi khi bj dm thddng chpn hinh thdc di kham ehda benh taJ cdc ed sd y te t d n h a n (34,3%) va di mua thud'e td ehda (31,6%). Viec di khdm ehda benh tai tram y te xd it ddde Ida chpn hdn (8,9%). Cung tUdng tU, ty le di khdm ehda benh tai eac benh vien trong nghien edu ndy la 14,6%, trong dd nam gidi ed ty le Ida chpn eao hdn d nd gidi (16,8% va 13,1%, p < 0 , 0 1 ) , (bieudd 1).
40 35 30
2
25•o- 20
15 10 5 0
D Nam n NCH
Tu' dieu tri Dong y Hieu thuoc Ty nhan TYT Benh vien Bieu dd 1. Md binh sd dung dich vu y te theo gidi cua ngudi dan huyen Ba Vi.
Nhin chung khi ngddi dan bj ho, sdt va dau d i u thddng lua chpn sd dung dich vu y te td nhan va mua thud'e tai cde hieu thud'e. Nhdng trddng hop bj tai nan thddng tfeh ehu ye'u lUa chen ede ed sd benh vien
la ndi khdm ehda benh (42,6%).
Bang 3. Lien quan gida lUa chgn loai binh dich vu y te vdi mdt sd ye'u td kinh te - xa hdi.
TUdieu trj Hi^u thudc Benh vien
Gidi tinh Nd Nam
9 5 % Cl
1 0,59 0,56 - 0 , 7 1
1 0,93 0,90 - 0 , 9 5
1 1,31 1,25 - 1,38 Kinh t l
Ngheo Trung binh
Khd
9 5 %
9 5 % Cl
Cl
1 0,91 0,87 - 0 , 9 5
1,05 0,99 - 1,11
1 0,97 0,93 - 1,01
0,86 0,81 - 0 , 9 0
1 1,07 1,02 - 1,13
1,25 1,18 - 1,34 Nghi
Ndng dan Cdng ehdc
Khde
9 5 %
9 5 % Cl
Cl
1 0,80 0,68 - 0 , 9 3
0,90 0,85 - 0 , 9 4
1 1,10 0 , 9 6 - 1,25
1,15 1,10 - 1,19
1 1,58 1,35 - 1,83
1,09 1,04 - 1,15 Hpe vdn
< Tieu hpc PTCS
>PTTH
9 5 %
9 5 % Cl
Cl
1 1,05 1,02 - 1,11
0,99 0,93 - 1,05
1 1,14 1,10 - 1,19
1,15 1,08 - 1,22
1 0,95 0,91 - 1,01
1,23 1,14 - 1,32
Ket qua phdn tich da bien cho thay cac yeu td gidi dnh, dieu kien kinh te, nghe nghiep va tnnh do hgc van cd lien quan den viec Ida chon sd dung loai hinh dich vu y te. Benh nhdn thudc hd gia dinh cd diiu kien kinh te khd han cd ty le Ida chon den kham ehda benh tai benh vien cao han d nhdm benh nhan thudc hg gia dinh cd dieu kien kinh te ngheo, (OR=l,25; p < 0,05). Benh nhdn cd trinh do hgc van cao han (td phd thdng trung hgc trd len) cung lifa chgn di khdm ehda benh tai benh vien nhieu han (OR = 1,22; p < 0,05), (bang 3).
IV. B A N L U A N 1. Mo hinh d^m dau
Ty le khai bao cd dm trong vdng mot thang trddc ngdy dieu tra Id 56,5%. Ty le nay eua D i l u tra Y te Qudc gia nam 2001 - 2002 la g i n 4 0 %
|3l. Cd n h i l u ye'u td ed the I n h hddng de'n ty le nay, nhd dia ban nghien edu, bd edu hdi ndo dirpc sd dung, ai la d i l u tra vien,...[4]. Trong d i l u tra diem ndm 2001 - 2002 tai 7 tinh/thanh phd eua Viet Nam, eau hdi phdng van ve tinh trang dm dau la "Trong vdng hai tuan qua cd ai trong gia dinh ta bi dm khdngi" Neu cd thi bi benh hay cd dau hieu g;?" Vdi can hdi nhd vdy rat ed the nhdng trieu chdng nhe se bj bd qua. Trong nghien cdu eua ehung tdi, sau cdu hdi v l cd sd kien dm ndo khdng, cdu hdi tiep theo v l mpt so trieu chdng thudng gap dirpc dat ra. Mat khde, trong nghien edu ndy, dieu tra vien dUde tap hud'n rat ky va viee dieu tra thu thdp cdc thdng tin v l dm dau Id cdng viec thddng quy da ddoc tien hdnh tai CO sd thdc dja trong sudt 10 nam qua, td nam
1999. Nhdng ly do tren cd the Id ede yeu td giup Idm gidm sd trddng hop dm bj bd sdt. Trong nghien cdu cua chung tdi, trung binh trong ndm 2008 mpt ngddi dan tai Ba Vi khai bdo ed 1,2 l l n dm, ket q u i nay cung tdong td vdi ket q u i cua D i l u tra Y te Qud'c gia (VNHS) 2001 - 2002 [3].
Md hinh dm trong nghien edu eua ehung tdi cung gidng vdi ket q u i eua c l e nghien edu khac tai Viet Nam [8|. Nghien cdu nay dd cho thd'y sdc khde vd md hinh dm dau d cdc nhdm tudi khde nhau rat khde nhau. Tre em vd ngUdi eao tudi cd sd lan dm cao hdn d ede nhdm tudi khde. Tre em ed ty le mac ho va sdt eao nha't, ngdde lai d ngddi gia ed ty le bj dau d i u va dau khdp la phd bien.
2. SiJ dung dich vu y te'
Trong nghien cdu nay, viec Ida chon di khdm ehda benh tai cdc cd sd y te td nhdn va tai cdc hieu thudc la rat phd bien (65,9%). K i t qua nay
phu hdp vdi ket q u i eua D i l u tra Y te Qud'c gia, eung cho tha'y cdc ed sd y te ngoai edng lap Id noi ngddi dan thddng Ida chpn de khdm ehda benh ngoai tru, hdn 5 0 % . Ben eanh dd, cd mdt ty le dang k l ddi tddng bj dm Ida chpn phddng thdc td dieu trj (23,4%). Tuy nhien, viec tU d i l u tri se gay ra n h i l u nguy ed vd h i l m hoa dd'i vdi sdc khde ngddi dan, nhd cae sal sdt trong td chan doan vd d i l u trj, sd lam dung thudc. Mat khde, hanh vi nay edn ed t h i gdy lang phi trong ehi tieu y te ddi vdi ngddJ dan. Nghien edu eua ehung tdi eung ehi ra r i n g cdc cd sd y te edng lap, dae biet Id tram y te xd ed vai trd ehda cao trong edng tdc khdm ehda benh. Chi ed 8,9% tdng sd cdc trddng hdp dm den khdm ehda benh tai tram y te xd vd 14,6% cdc trddng hdp Ida chpn loai hinh benh vien. K i t q u i nghien edu eua ehung tdi eung tUdng td nhd mpt sd cde nghien edu khac d Viet Nam [3, 5, 6|. Cd n h i l u nguyen nhan ddn den viec Ida chon cdc loai hinh dich vu y te ndy nhd:
phdp lenh "Hanh nghe Y ddde Td nhdn" dd Idm sd Iddng cde cd sd khdm ehda benh td vd nhd thudc td tdng len nhanh chdng, h l u nhd td't c l ede loai thud'e ddde bdn rpng rdi tren thj trddng ina khdng can cd chi djnh eua bde sT; cde tram y te xa hien nay khdng edn thu hut dUde nhieu khach hang nda vi den khdm ehda benh tai tram y te cung phai tra tien md nhieu khi lai khdng thuan tien.
Mdt sd nghien cdu dd chi ra r i n g , viec Ida chpn loai hinh djch vu y te bj I n h hirdng bdi rat nhieu ede y l u td, eu the Id: cdc chfnh sdeh tai chinh nhd phi kham ehda benh vd b i o h i l m y t l , yeu td eon ngddi ( c l edng va td nhan), td chdc vd gido due - ddo tao cdc eo sd y t l , dae diem cua he thdng ehdm sdc sdc khde (ngudn ldc vd hoat dpng cua cd sd y te); ddc diem v l ddn sd (cac nhdn to ddn d i t / k h a ndng va nhu cau); sd hdi long cua benh nhdn (loai hinh djch vu, sd tien loi, tinh lien tue cua djeh vu, chd't Iddng dich vu, hieu qua/dau ra cua djeh vu) [5, 7|.
Viec chi t r i phi kham ehda benh cd the trd thdnh gdnh ndng eho n h i l u hd gia dinh, d i l u nay dan den viec tri hodn tim kiem eac djch vu y t l hoac Ida chpn loai hinh djch vu kem chat Iddng nhdng ed gid thanh re hdn. Trong khi dd eac hd gia dinh cd thu nhap eao thudng chpn cdc ed sd y te ed chat Iddng nhd benh vien [6, 8].
V. KET LUAN vA KHUYEN NGHj
Ty le td khai bao d'm dau d nd cao hdn d nam gidi (62% va 51%). Ho, dau d i u , sdt va dau khdp la eae trieu chdng/benh phd bien d cdng ddng. 0 cdc nhdm tudi khae nhau thi md hinh benh/trieu chdng cung thay ddi. NgUdi ddn taJ huyen Ba Vi thudng chon hinh thdc di khdm ehda benh tai cdc CO sd y t l td nhdn, mua thudc tai hieu thudc vd td d i l u trj. Cdng tdc t r u y i n thdng giao due sdc khde e i n ddoc chd trpng vd tdng cddng vdi mue dich l i m gidm ty le td dieu trj. Ddng thdi, nganh y te cdn ndng cao vai trd cua he thdng y te edng trong cdng tdc khdm ehda benh eho ngddi ddn.
TAI LIEU T H A M KHAO
1. Bp Y te (2007). Nien gidm thdng ke, tr:
1 0 3 - 1 8 7
2. Bp Y te (2007). Bdo edo y te Viet Nam 2005, tr: 27 - 5 5 .
3. Bp Y te (2003) va Tong cue thdng ke.
D i l u tra y t l qudc gia, 2001 - 2002, tr: 98 - 11 5 4. Cecil G Helman (2001). Culture, Health and Illness 198 Madison Avenue, New York, NY 10016, pp: 38 - 4 2 .
5. Giang KB and Allebeck P (2003).
Self - reported illness and use of health services in a rural district of Vietnam: findings from an epidemiological field laboratory. Scand J Public Health 2003; 3 1 : pp. 1 - 7.
6. Khe N D ( 2 0 0 4 ) . SoeJoeeonomie differences in a rural district in Vietnam: effects on health and use of health services. PhD thesis.
Karolinska Institute, pp: 44 - 47, pp. 100 - 106.
7. Oanh TTM (2000). Self - reported illness and use of health services among elderly people in a rural district of Vietnam, pp: 25 - 37.
8. World Bank (2001). Vietnam - Growing Healthy - A Review of Viet Nam's Health Sector, Report 22210, pp: 25 - 29.
Summary
SELF - REPORTED ILLNESS AND USE OF HEALTH SERVICES IN BA VI DISTRICT, HA NOI IN 2008
Information on self - reported illness and the use of health services is important for planning of health services. Objectives: to describe and analyze the pattern of self - reported illness as well as the use of health services in Bavi, Hanoi. Methods: A population - based survey was conducted in the demographic surveillance site in Bavi, in 2008. Results and conclusions: The prevalence of self - reported illness was 55.5%. Cough, headache, fever and joint pain were the most commonly reported symptoms. Reported symptoms differed significantly by age group. Private sector (34.3%), pharmacy (31.5%) and self - treatment (23.4%) were commonly used. A significant difference was found between socio - economic groups in terms of the type of health service utilized.
Key words: Self - reported illness, symptom, use of health services