The growing burden of diabetes in Viet Nam

World Health Day 2016 Feature Story

Introduction

The World Health Organisation is celebrating World Health Day on 7 April 2016, with the theme Together on the frontlines against diabetes to highlight the need for multistakeholder action to halt the rise of diabetes worldwide.

Diabetes is now a global epidemic with a serious impact on the quality of life of individuals and families. It is a chronic disease that requires life-long treatment and thus leads to high economic burden to people and society.

Diabetes

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar.

There are 2 main forms of the diabetes: Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself.. Type 2 diabetes, Type 2 diabetes, the more common type, is usually seen in adults and occurs when the body becomes resistant to insulin or doesn't make enough of it. Diabetes can result in severe complications such as heart attacks, strokes, kidney failure, blindness and nerve damage in the feet that can lead to limb amputations.

Early detection is very important for the prevention and control of diabetes. It can be accomplished through relatively inexpensive blood testing. Treatment of diabetes involves lowering blood glucose and the levels of other known risk factors that damage blood vessels. Tobacco use cessation is also important to avoid complications. People with diabetes need to strictly comply with their treatment plan, which includes living a healthy lifestyle and taking their medication exactly as prescribed by their doctor. In addition they should always be aware of the risk of diabetes complications.

Burden of diabetes

In Viet Nam, the prevalence of diabetes is growing at alarming rates and has almost doubled within the past 10 years. Currently, it’s estimated that one in every 20 Vietnamese adults has diabetes. In addition, the number of people with a pre-diabetic condition is three times higher than those with diabetes.

Severe complications, such as feet ulcers, gangrene and resulting amputations, cardiovascular diseases, blindness and kidney failures are common in diabetic patients. These complications are the main causes of death and disability for people with diabetes. It’s estimated that about 53,458 deaths were attributed to diabetes in 2015 in Viet Nam.

The treatment costs, along with travel costs to hospitals as well as the loss of productivity due to illness and prolonged stays in hospitals can debilitate a whole family and drain funds for basic subsistence. According to International Diabetes Federation, the diabetes related expenditures in Viet Nam are on average 162.7 USD per patient per year in 2015. This is more than the average monthly salary of 150 USD in Viet Nam.

a diabetes patient with severe feet ulcers is being examined by a doctor at the National Hospital for Endocrinology in Hanoi
a diabetes patient with severe feet ulcers is being examined by a doctor at the National Hospital for Endocrinology in Hanoi
WHO/Quinn Ryan Mattingly

Behavioral risk factors contribute to diabetes

A number of behavioural risk factors contribute to diabetes, such as obesity, smoking, alcohol-abuse, unhealthy diet and insufficient physical activity. Therefore, a large proportion of diabetes cases are preventable. Simple lifestyle measures have been shown to be effective in preventing or delaying the onset of type 2 diabetes. Maintaining normal body weight, engaging in regular physical activity, and eating a healthy diet can reduce the risk of diabetes. The same measures help control and manage the disease to prevent complications.

In Viet Nam, these risk factors are observed among large parts of the population. According to a national survey in 2009/10, approximately 50% of adult men smoke; more than 25% of male drinkers consume alcohol at harmful levels; 80 % of Vietnamese men and women consume less than 5 servings of fruit and vegetables per day and nearly 30% of the population is physically inactive. Obesity is an important risk factor for diabetes. Although obesity in Viet Nam is not very common, the trend is increasing, especially in children. According to the National Institute of Nutrition, overweight and obesity in primary school children in Ha Noi increased from 7.9% in 2003 to 40.7% in 2011. However, In Viet Nam, diabetes is common even in non-obese individuals.

As Viet Nam continues to develop as a middle income country, where the average income increases and rapid urbanization happens, unhealthy diet and sedentary lifestyles will become much more common. These will further increase the risk for diabetes.

a Vietnamese man smoking in a restaurant
a Vietnamese man smoking in a restaurant
WHO/J Zak

Challenges in diabetes prevention and control in Viet Nam

  • Lack of awareness about diabetes across the population. The lack of awareness about diabetes results in the late detection and management of the disease. At the early stage, symptoms develop slowly and often people go on for years without knowing they have diabetes. It is estimated that more than 50% of patients with diabetes in Viet Nam are unaware of their condition.
  • Weak coordination across sectors to create a supportive environment : A supportive environment is key in promoting healthy lifestyles. This would include a combination of policies, laws and regulations and healthy settings such as tobacco-free settings and a built environment that promotes physical activity. In Viet Nam, policy coherence and multi-stakeholder engagement remains weak.
  • Access to services for the prevention, diagnosis and treatment for diabetes is difficult. Many of the commune health stations do not have the capacity to diagnose, treat and monitor diabetes, as well as provide follow-up care for patients. A substantial proportion of the health care staff at the primary level is not adequately trained to treat diabetes . Diabetic patients are required to travel to district, provincial or national level hospitals to seek treatment. This has led to a significant treatment gap among patients with diabetes in Viet Nam.
Information on diabetes at a provincial hospital in the Ha Nam province
Information on diabetes at a provincial hospital in the Ha Nam province
WHO/Quinn Ryan Mattingly

Diabetes disproportionately burdens the poor and those living in hard to reach areas:

Access and affordability of diabetes care and treatment are burdensome for the poor and those living in hard to reach areas. Ms. Hanh was diagnosed with type 2 diabetes 10 years ago, but she suspects she has suffered from the disease for much longer. She lives alone in the Doi Son commune in the Ha Nam province and the monthly visits to the district or provincial hospital for her regular check-ups and diabetes medication are a serious financial and physical burden to her. The journey is only 14 kilometres long, but requires for Ms. Hanh to rent a motorcycle taxi for a half-day because the waiting times at the hospital are long. Often she cannot afford to pay for the transportation and is therefore unable to get her regular medication.

The only other option is to buy her medication from a local, private pharmacy, where medicines are much more expensive and are not covered by the health insurance. Ms. Hanh often doesn’t have the money to buy her medicines and therefore her diabetes is not well controlled. As a result, she has been suffering from low vision, a common complication of diabetes. “When my blood glucose is stable, I can still see quite well. When it’s too high, I’m almost blind”, says Ms. Hanh.

The experience of Ms Hanh shows the importance of ensuring access to services for diabetes at the commune level – a direction that Viet Nam needs to pursue in order to ensure that diabetes care will be equitable and affordable to all.

Ms Hanh, a diabetes patient
Ms Hanh, a diabetes patient
WHO/Quinn Ryan Mattingly

The government response to diabetes in Viet Nam

Viet Nam has passed a national multi-sectoral strategy for non-communicable diseases (NCD) for the period of 2015-2025, which includes the prevention and control of diabetes. The national strategy outlines the following actions to prevent diabetes nationwide:

  • Promoting healthy lifestyles through multi-sectoral action. The government has taken the regulatory route as a key strategy for reducing risk and promoting healthy lifestyle. The Ministry of Health led in the advocacy against tobacco, leading to the approval of the law on tobacco in 2012. The ministry is now advocating for the approval of a law to restrict the harmful use of alcohol. Also, the Ministry of Health is launching a major health awareness campaign to promote a healthier lifestyle for the Vietnamese population.
  • Improving access to services for diabetes by inverting the pyramid of care. This can be done by strengthening the primary health care system to make services and long term care available to the people, and shifting diabetes care and long term treatment away from the hospital-based and mainly curative approach.
  • Improving collaboration among different levels of health providers, to ensure the continuum of care.
A Vietnamese family is given vegetables at the Ho Chi Minh City Nutrition Centre to encourage them to adapt a healthier diet
A Vietnamese family is given vegetables at the Ho Chi Minh City Nutrition Centre to encourage them to adapt a healthier diet
WHO/Quinn Ryan Mattingly

WHO’s support to Viet Nam in tackling diabetes

WHO supports the government of Viet Nam in tackling the diabetes problem. Its support includes the development of policies and interventions that would improve the capacity of the country in general, and its health system in particular to prevent and control diabetes. WHO pays particular attention to universal health coverage and equity so that everyone, regardless of their socio-economic status or geographical location, should be given healthy choices, live and work in healthy settings and have access to good-quality and affordable health care.

In order to achieve this, WHO supports the government through: generating evidence, including surveillance of diabetes to guide policy and decision-making processes; promoting awareness across the population; developing laws, policies and programmatic interventions; providing normative guidelines and standards and promoting healthy lifestyles. This year, WHO is strongly advocating for a multi-stakeholder action to tackle diabetes. WHO calls for everyone to come together on the frontlines against diabetes.

A nurse searches for medication for a diabetes patient at a provincial hospital in the Ha Nam province
A nurse searches for medication for a diabetes patient at a provincial hospital in the Ha Nam province
WHO/Quinn Ryan Mattingly

Empowering the frontlines to beat diabetes

The provinces, districts and communes are on the frontlines of the fight against diabetes. In this light, WHO is supporting the government to empower its localities to implement the NCD strategy through a multi-sectoral approach. In collaboration with the MOH, the WHO is guiding the initial implementation of the strategy in Ha Nam province. The focus is on strengthening its primary health care system by reforming regulations, improving the capacity of health care workers, ensuring the availability of basic services for patients with diabetes and strengthening collaboration of the health care networks across the districts in the province.

As part of this project, patients will be able to receive basic treatment for their diabetes at commune health stations. This will save patients a considerable amount of time, money and energy every month, as they will no longer have to travel to the district or provincial health facility for these services. Patient-centred care is important especially for elderly diabetes patients, to help them improve their compliance to treatment and to recognize diabetes complications. With the aim in view of ensuring equitable access to diabetes services for the majority of the population in Viet Nam, the WHO will continue to provide support to the MOH in guiding other provinces in the implementation of the national NCD strategy.

“We must maintain a clear focus on equity when advocating for a response to the growing prevalence of diabetes in Viet Nam. Our technical support to the government should enable the strengthening of the health system to ensure improved surveillance, enhanced prevention and more effective management of diabetes, especially at the grassroots level. It is our role to keep the most vulnerable parts of the population in mind and make sure no one is left behind” Dr. Lokky Wai, WHO Country Representative to Viet Nam emphasizes.

Nguyen Anh Phuong, a medical doctor in Han Nam, receives on-the-job training
Nguyen Anh Phuong, a medical doctor in Han Nam, receives on-the-job training
WHO/Quinn Ryan Mattingly

For more information, please contact

Ms. Tran Thi Loan
Tel: 84-4-38500100
Mobile: 0915 413 814
Email: media.vtn@wpro.who.int

Share