Describe the situation demands, using health care services from opiate addiction and the ability of Clinics of Social Labor Education Treatment Center in Ho Chi Minh City 2007.. Assess t
Trang 1Until 6/30/2012, there are about 171,400 people nationwide had opiate addiction with recordsmanagement, including Heroin addiction is still largely at a rate of about 84.7% In particular, according tothe survey results and practical struggle in many districts and the police of Ho Chi Minh City, the number ofaddicts is now up to about 30,000 people Opiate addiction crime increasing created insecurity in social life,causing great harm to the health, adversely affect national race, leaving serious consequences for futuregenerations
With the purpose of strengthening examination, treatment work and health care for opiate addictionpeople in the Social Labor Education Treatment Center, the thesis focused on the following objectives:
1 Describe the situation demands, using health care services from opiate addiction and the ability of Clinics of Social Labor Education Treatment Center in Ho Chi Minh City 2007.
2 Assess the effectiveness of some measures to strengthen health care activities for drugs rehabilitation people at the Social Labor Education Treatment Center (2008-2010).
* New contributions of the thesis:
On the basis of describing the opiate addiction situation and drug rehabilitation at 7 Social LaborEducation Treatment Center of Ho Chi Minh City we have intervened in Phu Van Treatment Center, hasshown remarkably effective: Rate student assess the ability of health services at high level after theintervention was increased from 12.2% to 15.7%, intervention efficiency rate reached 26.2% Rateconsulting practitioner at Health Center increased from 24.3% to 39.3%, intervention efficiency rate was52.3% Percentage student had health advice every sick time was increased from 80.7% to 21.8%,intervention efficiency reached 264.4%
* Layout of the thesis: The thesis consists of 119 pages: Introduction 2 pages; Chapter 1 –
Overview: 34 pages, Chapter 2 – Subjects and Methods: 19 pages; Chapter 3 – Results: 32 pages; Chapter 4
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Trang 2– Discussion: 29 pages; Conclusion: 2 pages; Recommendations: 1 page, 50 tables, 7 charts, 2 figures; 118references (88 in Vietnamese and 30 in English).
CHAPTER 1 OVERVIEW 1.1 Effect of narcotics to human health:
1.1.1 The concept of narcotics and opiate addiction:
* Narcotics: As derived substances, natural or synthetic, when introduced into the human body, it
has the effect of changing consciousness and physiology of the person If drug abuse, people will rely on it,
as it causes damage and harm to the user and the community
* Opiate Addiction: A state of the human body depends on one or more drugs, when used long-term
habit, caused state of "hunger" chronic drug in each period and the puppets disorders both physical andpsychological, harm to individuals and society addicts
1.1.2 Effect of narcotics:
Narcotics has affected to the drug users health, addicts, their family and society
1.2 The actual use of health care services of drug rehabilitation people in centers:
The care and recovery health for drug rehabilitation people (DRP) at the center were concerned: nutritiondiet, health care services in center, ensure personnel, health equipments, facilities, ensuring adequate treatmentdrug for drug rehabilitation people, especially the treatment of TB and HIV/AIDS; environment: enough cleanwater, waste, waste water
1.3 Solutions about the care and to improve health of drug addicts:
1.3.1 Solutions for health care management, treatment and health recovery:
+ Health Management: Risk for opiate addicts health was very high, the structure of disease of the
drug rehabilitation people was complex, high health care needs, it required health management: Medical record;Health monitoring cards; Organize health checks regular and irregular
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Trang 3+ Organize examination and treatment: detoxification, rehabilitation and treatment of infectious
diseases, ensure nutrition diet
1.3.2 Solutions of psychological therapy, health education:
+ Psychotherapy: Motivation objects; Create the trust of students; improve service quality, both in
terms of facilities and equipment qualification; raise the spirit of service, a sense of responsibility of healthworkers
+ Health Education: includes direct Health education, indirect Health education and organization of
peer education groups
1.3.3 Solutions related to social, community reintegration:
+ Fitness and sport: Slogan "Morning gymnastics, afternoon sports" for disease at Social Labor
Education Treatment Center
+ Labor therapy: Helps the body to function better, more flexible, help object reintegrate the
community: by organized, managed and monitored; appropriate to health of each people; observe labordiscipline
+ Other measures: Nutrition, Rest, Sauna, massage.
1.4 Results of implement Resolution 16/2003/NQ-QH11 in Ho Chi Minh City:
1.4.1 Communication activities, counseling, education: Contributing to alter perceptions, behaviors of
students, drug users, helping them to reintegrate into local communities back with a perfect personality
1.4.2 Literacy, vocational training: There were 17.279 people completed courses of vocational certificate,
which has long-term vocational equivalent grade 3/7 to 1.700 people and the number of diploma graduates is
830 people
1.4.3 Creating jobs for drug users: associated production activity, create jobs and improve lives, create jobs
in Nhi Xuan Industrial Zone, with Total Volunteer Team, in enterprise out School, Center
1.4.4 Practitioners health care and HIV/AIDS:
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Trang 4+ Division of the General Hospital and Specialist do as the following line to receive the case beyondthe capacity of the treatment; division hospitals supports professional group and specialty groups seekalternate-healing, exchange experiences with doctors and nurses of the centers.
+ Establish Tuberculosis unit, equipment investment, training on Tuberculosis control; open trainingcourses for people with HIV/AIDS program implementation VCT and antiretroviral therapy (drugAntiretroviral HIV) in the center; organization and replication peer education in the School, Center withmore than 1.000 participants…
CHAPTER 2 SUBJECTS AND METHODS 2.1 Object, location and time study:
2.1.1 Study subjects:
- The user of health services: Drug Rehabilitation People
- The supplier of health services: Medical staff
Trang 52.2.1 Study Design: The study cross-sectional descriptive survey combined with retrospective data analysis
and communities intervention compared before and after intervention and compared with the control group
2.2.2 Conceptual framework for the study:
- Independent variable: The drug rehabilitation people, Family, Health Department of Center
- Intermediate variable: demand for health care, behavior health services used by DR students;ability of health services to meet the health care
- Dependent variable: Some health care solutions for DRP
2.2.3 Method of cross-sectional descriptive survey:
Respondent sample size of drug rehabilitation people was counted by the following formula:
p (1 – p)
n = Z 2(1 /2) x DE
d2
Among them:
+ Z: The reliability coefficients, with probability = 5% threshold, with Z = 1.96
+ d: error acceptable, choose d = 0.025
+ p: Percentage using medical services of drug rehabilitation people in Center 2 weeks preceding the survey.Estimated p = 0.5
+ DE: Effective design, by design random sample many levels, so pick DE = 1.8
As the formula above we get n = 2,766 Practice has surveyed 2,800 people
2.2.4 Community intervention method:
Sample size of community intervention was calculated using the formula:
q1/p1 + q2/p2
5
Trang 6n = Z ( 21 /2) {ln (1 – )}2
Among them:
n: The minimum sample size
Z: The reliability coefficients, with probability limit =5%, we have: Z( 1 / 2 )= 1,96
p1: Percentage of students evaluate the ability of health services to meet the demand at the above averagelevel, according to the survey described as 76.1%, p1 = 0.76
q1: q1 = 1 – p1 = 1 – 0.76 = 0.24
p2: Percentage of students evaluate the ability of health services to meet the demand after intervention inmoderate or higher, the expected result is 90%, p2 = 0.90
q2: q2 = 1 – p2 = 1 – 0.90 = 0.10
: The relative error, choose = 7.5% Put the values in the formula, get n = 271, votes reserve is 10%, n =
298 In fact, 300 people were surveyed
Content of intervention methods:
(1) Training to enhance professional skills for medical staffs
(2) Health education for drug rehabilitation students in the Social Labor Education Treatment Center
(3) Fitness – sports methods, working therapy
(4) Measures of psychological therapy, recreation
2.3 Data processing:
- Research data collected will be handled according to the method of biomedical statistics, usingsoftware EPI INFO 6.04
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Trang 7- Using the techniques of data analysis and statistical comparisons, the test statistics: t test, 2
tocompare variables
- Assess the effectiveness of interventions: EI = ERA – ERB
ERA: The effectiveness rate of the intervention unit
ERB: The effectiveness rate of the control unit
2.4 Limited errors technicque:
- Random error by chance: Large enough sample size, different localities
- System error: Determining the right audience
- Wrong number of observations in the data collection: Questionnaires, training
- Error due to the confounders: Random sampling, stratified
to meet the demands of health department centers:
3.1.1 Some characteristics of participants in drug rehabilitation centers:
Study subjects (drug rehabilitation students) in Bo La Center is taking the highest number (601students), the lowest in Youth 2 Center (250 students) 7 centers also had male and female students, the
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Trang 8percentage of male students (83.0%), higher than female students percentage (16.1%) In particular, in PhuDuc, male students accounted for 97.9%.
Students at drug rehabilitation center the majority of young people, in detail: Below 18 years was2.5%, from 18-29 years old was 66.7%, 25.3% age of 30-39, the age group of 40 or older accounted for only5.5% The average age of participants was 28.9 ± 17.8 years
Education Level of drug rehabilitation students was very low: only 3.4% of participants withintermediate or higher professional, high school graduation was 21.0%, the rest i was secondary or less,including 5.7% are illiterate, 24.2% had primary education and secondary school qualifications was 45.7%
Average number of students came in the drug rehabilitation center is 1.2 times There are 85.1% ofparticipants firstly, 14.6% of participants came in the center 2-3 times, 0.3% of participants in the centerfrom 4 times or more
3.1.2 Demand for health care of drug rehabilitation practitioners in research centers:
3.1.2.1 The situation of drug use before students at the center:
Nearly 40.4% of participants was in the drug rehabilitation center over 36 months, the rate of students
in the drug rehabilitation center from 12-36 months was 35.7% and less 12 months was 23.9% The averagetime was 33.7 ± 7.6 months
3.1.2.2 Health situation of drug rehabilitation students in centers:
Number of times per month illness of DR students at the center was 0.8 times, the rate of 1 time sickwas 2.7%; 2 sick time was 1.1%, 3 sick time was 0.5%, 4 sick time was 0.3%, the sick time over 5 was 0.5%
In interviews with students, 31.3% of participants with test results HIV/AIDS (+), highest in PhuVan Center (44.5%) and lowest in Binh Duc Center (23.4 %) There was 46.9% of participants with testresults HIV/AIDS (-) and 21.8% of participants did not know/no answer (DK/NA)
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Trang 9There are 25.0% of participants in the drug rehabilitation center demanded for alternative medicine,which is the highest in the Youth 2 Center (38.8%) and lowest in Duc Hanh Center (18%) Rate of studentsnot wishing to use alternative medicine was 61%, with 14% of participants did not know/no answer.
There are 28.1% of participants said that their health was slightly better, 15.6% of participants saidthat much better There was 20.8% for practitioners health remain the same Especially, 30.4% ofparticipants said that health deteriorated
By outpatient examination in 2006: There were 38.2% of the total number of drug rehabilitationstudent visits sick, Binh Duc highest (85.5%), lowest in Duc Hanh (22.5%) In 2007, this ratio was 52.7%,the highest still in Binh Duc (89%), Binh Phuoc lowest (28.8%)
3.1.3 Use of medical services of drug rehabilitation practitioner in the drug rehabilitation center:
1 month before the survey, the nearest sick: 41.3% students needed medical station, 39.4% to thehealth facility, 5.1% received help from friends; 5.1% self treated, while 4.2% did not do anything
When HIV infection was suspected, students in the drug rehabilitation center were treated as follows:52.1% of participants would like to do voluntary testing, 18.2% of participants to the health facility foradvice, in contrast with 9.8% of participants did not handle anything, and 19.9% of participants didn’t know/
no answer
Through medical statistics and activities of the centers, the percentage of students at the center Test –Kit HIV result (+) was 39.4% (rapid test), in which the proportion of positive the fact that 92% (reaffirmed
in Ho Chi Minh City Preventive Health Center)
Only 59.3% of participants in the drug rehabilitation center has conducted HIV testing, Duc HanhCenter was the highest (69%), followed by Bo La Center (68.2%) , the lowest was Binh Duc (41.8%) Up to34.5% of participants did not have HIV test
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Trang 10In 2006, on average each month at 1 center organized 1 health education session, 2 sessions washighest (Binh Duc Center) However, Phu Duc, Bo La did not held any meeting In 2007, on average eachmonth at 1 center was 1.5 health education session, Binh Duc highest (2.5 times).
Table 3.18 shows that 29.4% of participants was consulted regularly every ill; 45.1% of the studentsbeing consulted but not often, 14.1% was not consulted and 11.1% did not know/no answer
Number of outpatient on average/year of students in centers were various: in Phu Duc highest (28.4times/person/year) and lowest in Phu Van (8,8 times/student/ year)
Average of the inpatient students in centers were different: Highest rate in Binh Duc (5.9times/person/year), followed by Youth 2 center (4.9 times/person/year) , Phu Duc was lowest (0.4time/person/year)
3.1.4 The ability to meet of the health centers on the health care needs of drug rehabilitation students:
Status of the students/staff at the research center: in 2006 and 2007: every 7.7 students get 1 officer,including 1 participant/61,8 health staffs
Health staff at the center: highest rate was asistant doctor (54.9%), followed by primary nursingschool (22.1%), nursing (7.2%), doctors only 4.1%
In 2 years (2006, 2007) at 7 research centers 3.1% of health workers were trained on drugrehabilitation and 20.5% of health staffs were trained on treating AIDS
Medical equipment rate of drug rehabilitation center being used overall 2 years (2006, 2007) theaverage was 84.1% The highest was in Bo La (96.5%) and lowest in Phu Duc (60.8%)
52.3% of participants assess the quality of health services at the research center in average level,good level of 27.9%, 7.7% is very good However, 6.8% of participants said that the health service was poorand 5.3% of participants DK/NA
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Trang 11Satisfaction ‘s student on the quality of health services at centers: 41.7% of participants satisfied atmoderate level, 21.9% are very satisfied However, there are 10.4% of the students were not satisfied and16% students less satisfied, with 9.6% of participants didn’t know/no answer.
Regarding the ability of health services to meet the demand: 63.3% of participants said at themedium level, high level response was 12.8% lower response level was1.7%, no response was 6.9%
3.2 Assess the effectiveness of some measures to strengthen health care for drug rehabilitation people
in centers:
3.2.1 Results of the implementation some interventions in Phu Van:
Table 3:28 Results of health staffs training in drug rehabilitation at Phu Van Center
Content
In 2008 (n = 41)
In 2009 (n = 45)
In 2010 (n = 45)
The drug detoxification support for
drug rehabilitation people
Recovering health care for drug
In 2009 (n = 45)
In 2010 (n = 45)
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Trang 12Treatment of patients with AIDS 35 85.4 39 86.7 41 91.1
Table 3.30 Results of health staffs training on Communication-Health Education in Phu Van
Table 3.31 Result of indirect communication for Drug Rehabilitation People behavior change in Phu Van
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Trang 13Panels, posters (units) 54 63 63
Table 3.32 Results of direct communication for Drug Rehabilitation People behavior change at Phu Van
No of session
No.of people
No of session No.of people
No of session No.of people
CHE: Communication-Health Education
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Trang 14Table 3.33 Results of psychological therapy, recreation for students in Phu Van
Content
No of session people No.of session No of people No.of session No of people No.of
3.2.2 Effect of some interventions to improve health care activities for Drug Rehabilitation People in Phu Van center:
Table 3.34 Percentage of students self-assess the health situation in center 3 months after intervention
(AI) and before intervention (BI) Indicators
Intervention center Control center
IE (%)
Trang 15Did not Know /
No Answer
Compare p1,2 (*)<0.001; p 2,4(*)<0.001
p1,2 (**)<0.05; p 2,4(**)<0.05The table 3.34 showed the results: Percentage of students self-assessment of their health status werebetter after coming to DRC has increased after intervention was statistically significant:
- Percentage of students assessed health slightly better was increased from 26.2% before theintervention to 40.0% after intervention with p <0.001 and higher than controls (40.0% compared with21.3%), the difference was statistically significant with p<0.001, effective interventions to reach 42.7%
- Percentage of students assessed much better health was increased from 8.8% before theintervention to 15.3% after intervention with p <0.05, and higher than controls (15.3% compared with 9.3%)with p <0.05, intervention efficiency to reach 23.9%
Table 3.35 No of sick times 1 month before investigation by Drug Rehabilitation People BI and AI
Trang 16Table 3.35 showed, the proportion of students got the sick times in month high (5 times or more)was lower than before intervention (0.3% compared with 0.8%) and lower than the control (0.3% comparedwith 0.8%) Average number of sick time in a month before the survey was lower than before intervention(0.5 time compared to 0.8 time) with p <0.001 and lower than controls (0.5 time to 0.9 time) with p <0.001.
Table 3.36 The rate of Drug Rehabilitation People through outpatient examination at center BI and AI
Indicators
EI (%)
Results Table 3.36 shows: Incidence of Drug Rehabilitation People through outpatient examination
at centers, after intervention was lower than before intervention and lower than the control centers, in details:reduced from 69, 4% before the intervention to 42.7% after the intervention (at intervention center) with p
<0.001 This rate in the intervention center was also lower than that in the control center (42.7% compared to69.0%), the difference is statistically significant with p <0.001, effective intervention at 26.5%
Table 3.37 Ratio of staff and participant in the DRC before and after intervention
BI (1) AI (2) BI (3) AI (4)
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