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Nguyen Lan Huong GRSP Country Manager for Vietnam 9/11/2009, HCMC, Vietnam

GRSP Viet Duc Hospital & St Paul Hospital NEU. Alcohol Consumption of Road Traffic Victims at Viet Duc and Saint-Paul Hospitals. Nguyen Lan Huong GRSP Country Manager for Vietnam 9/11/2009, HCMC, Vietnam. background.

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Nguyen Lan Huong GRSP Country Manager for Vietnam 9/11/2009, HCMC, Vietnam

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  1. GRSP Viet Duc Hospital & St Paul Hospital NEU Alcohol Consumption of Road Traffic Victims at Viet Duc and Saint-Paul Hospitals Nguyen Lan Huong GRSP Country Manager for Vietnam 9/11/2009, HCMC, Vietnam

  2. background • 2000: GRSP started our plan of long term collaboration with GOVN in order to sustainably reduce road traffic fatalities and injuries • 2006: successful collaboration in helmet, on going • 3/2009: DD GPM, Nat’l DD Seminar,NTSC, GRSP, WHO, MOH • Data and analysis on DD was limited • Is alcohol consumption in Vietnam a key contributor to traffic accident? • Future priority projects? • A national DD action plan to be developed and submitted to GOVN office.

  3. objectives • To synthesize activities and projects related to alcohol overuse and intervention implemented in Vietnam from 2002 up to now • To input data on drink-driving crashes at Viet Duc and Saint Paul Hospitals in Hanoi • To evaluate the alcohol consumption situation of crash victims admitted to the hospitals • To evaluate consequent factors between drink-driving and victims’ health and hospital costs

  4. Target group Target of study Situation, attitude and behavior of road traffic victims towards alcohol consumption Target group Road traffic victims: • Over 16 years old • Road crash victims within 8 hours since collision happened • Hospitalized, stayed for monitoring at clinic, minor operation, including deaths caused in the hospital and clinic (The study is not applicable for victims returning home after check-up or death before arriving at hospital and clinic). Sample size: 775

  5. Study on available documentation Road Traffic Law Previous studies, projects, researches Qualitative data In depth interviews with representatives of GOVN agencies (NTSC, C26, MOH’s PMD) In depth interviews with representatives of int’l and NGOs (WHO, JICA…) Quantitative data Questionaire, refering to MOH’s questionaire Interview, and collection of data from different faculties of the hospital BAC testing results provided by Viet Duc Hospital. methodology

  6. Timeframe From 11/08 – 01/09: TOR, proposal and study plan From 02/09 – 05/09: Implementation, data collection and analysis, report Interviewers: NEU researchers Doctors, medical staff of Viet Duc and St Paul hospitals 2 trainings at each hospitals: pilot then actual interview (questionaire revised after the pilot) Methodology

  7. Study location Viet Duc hospital Training St Paul hospital • 2 hospitals of ViÖt §øc vµ Saint Paul – Hµ Néi Interview

  8. Epidemical study with multi-implementing agencies (IPSI- NEU, Viet Duc Hospital, and Saint Paul Hospital in Hanoi) + carried out after having approval from relevant agencies Personal information of victims: respected and kept confidential as a principle, recorded under bar codes stipulated by study guideline The study results serve to improve the  drink-driving situation MORAL OF THE STUDY

  9. At hospital, with injured victims: difficult to collect all required data Victims admitted to different faculties, under supervision of different doctors. Q’naire must go through several faculties. Time consuming, missing data, interuption in interviews. Samples: Victims over 16 yrs, no death before arriving hospital, within 8 hours from the accident. RESTRICTION

  10. KEY FINDINGS

  11. SYNTHESIS OF ACTIVITIES, INTERVENTION PROJECTS AND RESEARCHES implemented in Vietnam from 2002 to present • Penal Code Number 15/1999 QH 10 • (Article 202 – drunk term, not yet legal BAC) • Traffic Law in 2001 • ( Article 8, para 8 – over 80 miligam/100 mililit blood or 40 miligam/1 liter of breath (BAC and BrAC not consistant, no difference btw riders and drivers) • Traffic Law in 2008 (effective from 1/7/2009) • (Article 8 para 8- over 50 miligam/100 mililit blood or 0.25 miligam/1 liter of breath” to MC riders; and O to drivers

  12. SYNTHESIS OF ACTIVITIES, INTERVENTION PROJECTS AND RESEARCHES implemented in Vietnam from 2002 to present • GOVN agencies + NTSC and provincial TSCs • Traffic safety PE in collaboration with social and economic orgs. Leaflets – Things that Drivers and Riders need to know • Collaboration with NGOs • Not yet separated PE on DD • C26: enforcement + behavior change education

  13. SYNTHESIS OF ACTIVITIES, INTERVENTION PROJECTS AND RESEARCHES implemented in Vietnam from 2002 to present • Hanoi DOT • Enforcement: not much, only in combination with riders/ drivers’s traffic • PE: leaflets- Things that Riders and Drivers need to know, MOET curriculum participation, road traffic law competitions • Not yet separated PE on DD

  14. SYNTHESIS OF ACTIVITIES, INTERVENTION PROJECTS AND RESEARCHES implemented in Vietnam from 2002 to present • MOET • Traffic safety and Road Traffic Law curriculum at all levels of school. • Collaborated with C26, NTSC to develop teacher ‘s manual and student’s workbooj on traffic safety • Drink no Drive is one of the themes

  15. SYNTHESIS OF ACTIVITIES, INTERVENTION PROJECTS AND RESEARCHES implemented in Vietnam from 2002 to present Scientific researches / studies on DD MOH’s GDPMEH • “Statistics on fatalities due to injuries and accidents” every 2 year • Research of accidents relating to DD situation and awareness on Hanoi 2 districts and Hung Yen. Initial study, stopped due to shortage of fund. • HSPH, Medical University of Hanoi, of Hue etc. Projects: WHO, JICA, Honda, VIA, TCTRBNGK…

  16. RESULTS FROM FOCUS INTERVIEWS AT 2 THE HOSPITALS Demographic specifications of study targets • Per age and sex Most are male Graph 1.1: Percentage distribution of study targets by age and sex (%)

  17. Demographic specifications of study targets • Per education level Graph 2: Percentage distribution of study targets by education (%)

  18. Demographic specification s of study targets Per occupations: Free labourers 27,7%, farmers 15,6%, Blue collars 15,5% Graph 1.3: Percentage distribution of study targets divided by occupation (%)

  19. Evaluation of drink-driving situation • Alcohol positive is very high 56,4%. • 29,4% exceed legal BAC regulated in RTL 2001 • Per RTL 2008: 33,4% exceed BAC Graph 4: Percentage distribution of study targets related to BACs and exceeding legal limit regulated by traffic law (%)

  20. Evaluation of drink-driving situation • At all ages, male has higher BACs than female Graph 5: BACs distribution of study targets divided by sex and age group (%)

  21. Evaluation of drink-driving situation • High school and secondary school age have higher BACs than others Graph 6: BACs distribution of study targets by education (%)

  22. 100.0 100.0 90.0 80.0 72.7 71.7 70.0 66.7 61.7 62.8 60.0 52.1 47.4 47.4 50.0 40.0 33.3 30.0 20.0 10.0 0.0 Officer Soldier-Poilice Farmer Free labour Driver Indistinguishable Pupil-Student Worker Retired people Other Evaluation of drink-driving situation • Drivers has the highest BACs Graph 7: Distribution of BACs of study targets by occupation (%).

  23. Evaluation of drink-driving situation Graph 8: Percentage Distribution of study targets regarding alcohol use habits (%) Only 38,1% always use non alcohol. Often use different types of alcohol is over 50% G9: Percentage Distribution of study targets regarding alcohol use frequency: daily or weekly (%) 3,9% drink everyday At least once/ week is 3,7%. 1 – 3 days / mth: Highest, 26,6% .

  24. Evaluation of drink-driving situation Over one third accept having drunk alcohol within 8 hours prior to collition, mainly male 37,2% in general. 47,3% in male Graph 10: Percentage Distribution of road crash victims investigated who accept having drunk alcohol 8 hours before collision by sex (%)

  25. Evaluation of drink-driving situation In 288 samples who accept having drunk within 8 hours prior to collision, 94,8% is male “Did not remember” (the quantity of drinks) is very high 36,3%. G11: Percentage Distribution of investigated males regarding alcohol consumption level within 8 hours before collision (cup for wine/glass for beer) (%)

  26. Evaluation of relevant factors to road crash, health and alcohol use Weekends have higher percentage of accidents. Fri 17%, Sun 17.7% G12: Percentage Distribution of road crash hours by days (%)

  27. Evaluation of relevant factors to road crash, health and alcohol use Going out hours have the highest of accident percentages: 31.2%. Total sum of accidents within working hours are high, 28.8% G13: Percentage Distribution of involving road crash by hours (%).

  28. Evaluation of relevant factors to road crash, health and alcohol use Highest alcohol positive: going out time. Followed by in working hours Table 1: Percentage Distribution of period having road crash by hours and with BACs

  29. Evaluation of relevant factors to road crash, health and alcohol use G 14: Percentage Distribution of type of vehicle used by road crash victim (%) . 82.8%victims use MCs, in which more than ½ of victims are alcohol positive G15: Percentage Distribution of study targets by type of vehicles and with BACs (%)

  30. Evaluation of relevant factors to road crash, health and alcohol use Most of the collisions are with motorbikes (52,8%). 14,8% self falling G16: Percentage Distribution of the type of vehicles that had collision with victims (%).

  31. Evaluation of relevant factors to road crash, health and alcohol use In all collisions, BACs of the drivers/ riders are high, from 52,9% to 65,2% In self, falling, BACs exceed 65% G17: Percentage Distribution of vehicle drivers/riders that had collions with victims due to BACs (%)

  32. Evaluation of relevant factors to road crash, health and alcohol use 73% of the victims are drivers/ riders G18: Percentage Distribution of interviewees by their position on vehicles when in the collision (%) G19: Distribution of interviewees by their position on vehicles and with BACs (%). Approx 60% victims are riders/drivers with BACs

  33. Evaluation of relevant factors to road crash, health and alcohol use Helmeted motorcyclists are 65,5%. G20: Percentage Distribution of victims using safety devices – Helmet (%) - BAC victims have higher % of not using safety devices than no BAC victims - % of not using safety devices reduces per age groups: 16-24, 25-44, 45-59, 60+ are accordingly 19,4%, 16,1%, 15,2% và 7,4%.

  34. Evaluation of relevant factors to road crash, health and alcohol use Head injuries in BAC victims are 61,1%, vs 38,9% in no BAC victims Similarly, face injuries:70,5% vs 29,5% Multi injuries: 68,0% vs 32,0%. Especially, there is close connection btwn BAC and injured parts of bodies. Equiv in head and face (Equiv. P value = 0.004 và 0.003) G 21: Percentage Distribution of study targets by injured parts of their bodies and having BACs (%)

  35. Evaluation of relevant factors to road crash, health and alcohol use Risk of injuries increases when victims are alcohol positive. Table 2: Percentage Distribution and the risk of having injured parts of victims with BACs Risk of head injuries in the BAC victims is 1.5 times higher than no BAC victims. Face: 2 times higher; multiple injuries is approx 1,7 times.

  36. Evaluation of relevant factors to road crash, health and alcohol use Road Traffic Law obbeydiance will reduce credibly injury risks. Head injuries reduce from 2.5 times to 2.1 Face injuries reduce from 1.8 times to 1.6 times Table 3: The risk of having injured parts of victims with lower and higher BACs level than legal limit in Traffic Law 2001 and 2008

  37. Evaluation of relevant factors to road crash, health and alcohol use BAC victims have higher % of internal injury/ wound or internal injury/ wound than no BAC victims G 22: Study targets distribution by injuries mechanism and having BACs (%)

  38. Evaluation of relevant factors to road crash, health and alcohol use BAC victims have higher Glasgow points than no BAC victims (G<=8 is dangerous) G 23: Percentage Distribution of interviewee by Glasgow point and having BACs

  39. Evaluation of relevant factors to road crash, health and alcohol use Over 50% of victims are hospitalised from having treatment at clinic, emergency room % of victims being examined, treated and discharged home (slight injuries) is only 14,7%. G 24: Percentage Distribution of victims having treatment at clinic and/or emergency room (%)

  40. Traffic accidents and Drink drive 379 victims hospitalised and diagnosed with final injury. 2 main injuries are head trauma 42.3% & extremities fractured 38.1%. Graph25: Percentage Distribution by final injury (%)

  41. Traffic accidents and Drink drive victims with BACs often have higher risks of being injured than non BACs victims; spinal injury is an exception Graph 26: Percentage Distribution of interviewees by final injury and having BACs (%)

  42. Traffic accidents and Drink drive Significant differences in further treatment among the BACs victim group and non BACs (31.4% compared to 19.3%, respectively). Graph 27: Percentage Distribution of investigated group by further treatment and having BACs (%)

  43. Awareness / Knowledge of the investigated group Graph 28: Percentage distribution of interviewees that know about the legal BACs level for drivers as stipulated in the Traffic Law (%) Knowledge at alarming level: 81.3% do not know about the legal BACs and BrACs

  44. Awareness / Knowledge of the investigated group Graph 29:Percentage distribution of interviewees that had travelled as passengers with drinking drivers 47.8% of the interviewed victims had travelled as passengers with drinking driverswith varied frequencies (34.5% under 10 times/ year & 13.3% over 10 times/ year), indicating that victims do not have the right behaviors on DD

  45. Awareness / Knowledge of the investigated group Most victims know the bad influences of drinking then driving Graph 30: Ratio of interviewees who supported solutions for limiting alcohol use when driving

  46. Treatment expenses Most victims do not obtain health insurance (61.9%) Graph 31: Percentage distribution of victims obtaining health insurance (%) Note: Victims with BACs not to receive allowance as stipulated in Health Insurance Law 2008, Article 23

  47. Treatment expenses Victims with BAC pay more than those without BAC Table 4: Hospital treatment fee 25% victims pay 617.000 đ and below, 25% victims pay 3.574.000 đ and above (6 times of the minimum salary)

  48. Treatment expenses Tendency of treatment costs to increase sharply if the legal BACs increases: 50% of road crash victims with the legal BACs level stipulated in Traffic Law 2008 (up to 50mg/100ml blood), have to pay hospital fees higher than those non BACs - an amount of 113% above the minimum stipulated salary. Graph 32: The different rate of treatment costs for victims with BACs and those without BACs, based on the inter quartile range (to be counted per the minimum stipulated salary of VND 540,000/month)

  49. Treatment expenses • Average treatment expenses per victim is approx. 2.823.000 VND • Excluding caretaker expenses and other losses caused by the work disability, opportunity costs of victims and caretaker • Excluding state economic and social costs as well as of the victims Hospital treatment exp = 23,000 victims (per MOH statistics) x 2,823,000 = 65 billionVNĐ Trend not statistics.

  50. Opportunity costs Graph 33: Distribution of target group based on the disclosed opportunity cost of victims and the main caretakers (%) Loss of biz development and expansion is highest (both victims and mian caretakers): 48,4% & 41,9% Loss of taking care of children follows at 31,5% & 35,7%

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