1 BACKGROUND Until 6/30/2012, there are about 171,400 people nationwide had opiate addiction with records management, including Heroin addiction is still largely at a rate of about 84.7% In particular, according to the survey results and practical struggle in many districts and the police of Ho Chi Minh City, the number of addicts 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 future generations With the purpose of strengthening examination, treatment work and health care for opiate addiction people 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 Labor Education Treatment Center of Ho Chi Minh City we have intervened in Phu Van Treatment Center, has shown remarkably effective: Rate student assess the ability of health services at high level after the intervention was increased from 12.2% to 15.7%, intervention efficiency rate reached 26.2% Rate consulting practitioner at Health Center increased from 24.3% to 39.3%, intervention efficiency rate was 52.3% 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 2 – Discussion: 29 pages; Conclusion: 2 pages; Recommendations: 1 page, 50 tables, 7 charts, 2 figures; 118 references (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 and psychological, 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: nutrition diet, health care services in center, ensure personnel, health equipments, facilities, ensuring adequate treatment drug for drug rehabilitation people, especially the treatment of TB and HIV/AIDS; environment: enough clean water, 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 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 health workers + 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 labor discipline + 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: 4 + Division of the General Hospital and Specialist do as the following line to receive the case beyond the capacity of the treatment; division hospitals supports professional group and specialty groups seek alternate-healing, exchange experiences with doctors and nurses of the centers + Establish Tuberculosis unit, equipment investment, training on Tuberculosis control; open training courses for people with HIV/AIDS program implementation VCT and antiretroviral therapy (drug Antiretroviral HIV) in the center; organization and replication peer education in the School, Center with more 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 2.1.2 Study sites: - Phase 1, describes the situation: 7 Social Labor Education Treatment Centers, Department of Labour, Ho Chi Minh City - Phase 2, intervention: Phu Van Health Center 2.1.3 Study period: - Phase 1: Survey describes the current status and development of interventions from 01/2007 – 12/2007 - Phase 2: Apply and evaluate the effectiveness of interventions, from 01/2008 – 6/2011 in Phu Van Health Center 2.2 Research Methodology: 5 2.2.1 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−α / 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 6 n= Z 2 (1−α / 2 ) Among them: n: The minimum sample size {ln (1 – ε)}2 Z: The reliability coefficients, with probability limit α=5%, we have: Z (1−α / 2 ) = 1,96 p1: Percentage of students evaluate the ability of health services to meet the demand at the above average level, 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 in moderate or higher, the expected result is 90%, p2 = 0.90 q2: q2 = 1 – p2 = 1 – 0.90 = 0.10 ε: The relative error, choose ε = 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, using software EPI INFO 6.04 7 - Using the techniques of data analysis and statistical comparisons, the test statistics: t test, χ 2 to compare variables - Assess the effectiveness of interventions: EI = ER A – 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 2.5 Research Ethics: - Serving the interests of the drug rehabilitation people, only those interviewed voluntarily participate in the study - Keep confidential all information of drug rehabilitation people and is only used for research purposes CHAPTER 3 RESEARCH RESULTS 3.1 The situation demands, using health care services of practitioner's drug addiction and the ability 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 (601 students), the lowest in Youth 2 Center (250 students) 7 centers also had male and female students, the 8 percentage of male students (83.0%), higher than female students percentage (16.1%) In particular, in Phu Duc, male students accounted for 97.9% Students at drug rehabilitation center the majority of young people, in detail: Below 18 years was 2.5%, from 18-29 years old was 66.7%, 25.3% age of 30-39, the age group of 40 or older accounted for only 5.5% 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 with intermediate 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% of participants firstly, 14.6% of participants came in the center 2-3 times, 0.3% of participants in the center from 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 average time 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 sick was 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 Phu Van Center (44.5%) and lowest in Binh Duc Center (23.4 %) There was 46.9% of participants with test results HIV/AIDS (-) and 21.8% of participants did not know/no answer (DK/NA) 9 There 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 students not 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 said that much better There was 20.8% for practitioners health remain the same Especially, 30.4% of participants said that health deteriorated By outpatient examination in 2006: There were 38.2% of the total number of drug rehabilitation student 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 the health 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 for advice, 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 Hanh Center was the highest (69%), followed by Bo La Center (68.2%) , the lowest was Binh Duc (41.8%) Up to 34.5% of participants did not have HIV test 10 In 2006, on average each month at 1 center organized 1 health education session, 2 sessions was highest (Binh Duc Center) However, Phu Duc, Bo La did not held any meeting In 2007, on average each month 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 students being 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 (28.4 times/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 (5.9 times/person/year), followed by Youth 2 center (4.9 times/person/year) , Phu Duc was lowest (0.4 time/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 nursing school (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 drug rehabilitation 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) the average 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 poor and 5.3% of participants DK/NA 19 - Satisfaction level was increased from 16.3% before the intervention to 23.7% after intervention with p