The operative phase of the ECOMORE project in Vietnam started immediately after the 1st National Stakeholders Meeting held on 7th August. From 22 to 25 August 2018, the ECOMORE team represented by Dr. Le Thi Phuong Mai and Mr. Tran Van Dinh visited hospitals in Mekong Region Delta and more specifically in Cantho province, one of the three selected areas to conduct the Leptospirosis survey. These visits aimed at informing medical personnel who will be involved in the project on the objectives and protocol of the study; comments and questions raised during the discussions were critical to better understand organization at hospital, especially screening of out-patients and these meetings showed that all the medical teams are really motivated to implement this project.
4 hospitals have been visited, 2 hospitals situated in Cantho city center, Cantho General Hospital and Cantho Hospital of Pediatrics, 1 hospital in sub-urban area, Phong Dien General Hospital and 1 hospital in rural area, Thot Not General Hospital. All this hospitals have an Infectious Diseases Unit. Every day they screen from 450 out-patient (Phong Dien General Hospital) to 2,200 out-patient (Cantho General Hospital).

Surprisingly, both City hospitals have identified Leptospirosis cases (use of RDT tests) but the hospitals in sub-urban and rural areas where main activity is rice farming, did not. It points out the need to raise awareness and to provide lab testing support (and -20oC freezer to conserve samples for the secondary hospitals) to Medical Doctors.

Cantho City under the rain from the General Hospital

Phong Dien Hospital in sub-urban settings

Some severe cases of Leptospirosis have been identified at Cantho General Hospital but likely some fatal cases are rather diagnosed as acute renal failure or lung hemorrhages. Pr. Yupin Suputtamongkol from Mahidol University, who participated in a 3-day Working Group on Leptospirosis in Yangon, mentioned that in Thailand 10% of sepsis of unknown cause have been found to be Leptospirosis.
Doctors interviewed are not sure to be able to identify mild form of Leptospirosis at OPD because clinical signs of the disease are not specific; it is why NIHE decided to use a case definition very sensitive but not so specific at the beginning of the project to make sure not to miss cases.
All hospitals stated that sampling a second time suspected patient will be a challenge; a compensation is budgeted; the pilot phase will be critical to assess if it is sufficient to convince suspected patients to be sampled one more time, 10 days to 2 weeks later.
Finally, Medical Doctors who practice both at hospital and in the private sector, recognize that some mid-cases should be seen by private doctors but medical care is free at OPD in Vietnam and likely the low-income people will be treated at hospitals
The next step will be to visit hospitals in Ha Tinh province in Central Vietnam from 28 to 31 August 2018 and in Thai Binh province in North Vietnam on 04 and 05 September 2018.

OPD at Phong Dien Hospital

OPD at Cantho Hospital of Pediatrics

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