A wider range of social protection services, including social insurance and social assistance, are gaining global attention as a key driver of improved health service coverage and financial protection among vulnerable populations. However, only a few studies have investigated the associations between social protection and universal health coverage (UHC). Therefore, we conducted a literature review on relevant international organizations with respect to this topic. We found that many international organizations consider the wide range of social protection services, including social insurance and social assistance, essential for achieving UHC in 2030. In specific health programs, social protection is considered an important service to promote health service access and financial protection, especially among vulnerable populations. However, discussions about social protection for achieving UHC are not given high priority in the World Health Organization. Currently, the coverage of social protection services is low among vulnerable populations in low- and middle-income countries. To address this issue, we employed the metrics recommended by the migrant integration policy index (MIPEX). Based on our findings, a conceptual framework was developed. We expect this framework to lead synergy between social protection and health systems around the globe, resulting in healthy ageing.

Data on incidence of snakebites and the responsible snake species are largely missing in Vietnam and comprehensive national guidelines for management of snakebite envenoming are not yet available. They are needed to estimate the scope of this health problem, to assess the demand for snake antivenom and to ensure the best possible treatment for snakebite victims. A cross-sectional community-based survey was conducted from January to April 2018. Multistage cluster sampling was applied and snakebite incidence in Can Tho municipality, excluding two central districts of Can Tho city, was calculated at 48 (95%-confidence interval (CI): 20.5–99.8) snakebites per 100,000 person-years. Seven snakebite victims found during the survey reported 3 bites from green pit vipers and 4 bites from non-venomous snakes. In 2017 two treatment centres for snakebite envenoming in Can Tho city, the Military Hospital 121 and the Paediatric Hospital, received 520 admissions of snakebite victims. Two hundred sixty-seven came from Can Tho Municipality and 253 from neighbouring provinces. According to these data, the incidence of snakebites for Can Tho municipality was calculated at 21 (95%-CI: 18.5–23.7) snakebites per 100,000 person-years. Incidence was 14 (95%-CI: 12–17) snakebites per 100,000 person years in those 7 districts of the municipality which were part of the community survey. Green pit vipers were responsible for 92% of snakebite envenoming. Antivenom, antibiotics and corticosteroids were administered to 405 (90%), 379 (84%), and 310 (69%) out of 450 patients, respectively. Incidence of snakebites in Can Tho Municipality is relatively low and green pit vipers are responsible for the vast majority of bites. Approximately one third of snakebite patients sought medical care in hospitals and although hospital data still underestimate the real incidence of snakebites, these statistics are valuable and can be obtained fast and inexpensively. Evaluation of patients’ records indicates the need for development of guidelines for management of snakebite envenoming in Vietnam to ensure a rational use of antivenom and ancillary treatments. The World Health Organization included snakebite envenoming into the list of neglected tropical diseases in 2017 and launched a strategy for prevention and control of snakebite envenoming in 2019 in order to reduce the number of deaths and cases of disability by 50% before 2030. The neglect includes first and foremost epidemiology of snakebites, knowledge about management of snakebite envenoming and the medically relevant snake fauna, and access to life saving treatment with snake antivenom. In Vietnam reliable data on snakebite incidence and on snake species responsible for envenoming are largely missing. The present community-based survey showed that incidence of snakebites in Can Tho Municipality in the Mekong Delta in South Vietnam is significantly lower than in neighbouring countries and lower poverty rates among others are most likely the principal reason. Green pit vipers are responsible for the vast majority of snakebites. Treatment practices need to be reviewed and national guidelines are needed to achieve the best outcome for snakebite patients.

Snakebite envenoming presents a significant burden to the health care system in Vietnam. However, data on snakebite-related hospital visits and the availability of antivenom across the country remain scarce. Furthermore, details on clinical presentation, responsible snakes, and treatment practices are lacking. In this retrospective, cross-sectional study, we collected data on snakebite-related visits and antivenom availability in major hospitals across 40 provinces from 2018 to 2022 and analysed a subset of patients' files. We displayed the geographical distribution of snakebite-related visits, available antivenoms, and responsible snake species across Vietnam, described the clinical presentations of envenoming, and assessed the appropriateness of treatment practices. We recorded 23 877 snakebite-related visits from 2018 to 2022. Antivenom was available in 29 of 62 (46.8%) hospitals, more commonly in the southern provinces. In 2024 patient files, signs of haemotoxic envenoming and neurotoxic envenoming were recorded in 445 (22.0%) and 59 (2.9%) patients, respectively. The most frequently recorded snake genera were Trimeresurus and Naja. Antivenom was administered to 434 (33.9%) of the 1280 patients from antivenom-equipped hospitals. Ancillary treatments were commonly used: 1076 (53.1%) patients received antibiotics, and 940 (46.4%) received corticosteroids. In-hospital mortality was low at 0.3% and was mainly due to neurotoxic envenoming. We recorded a considerable number of snakebite-related visits in participating hospitals; however, antivenom availability was limited, and treatment practices were often inappropriate. Improving access to antivenom and updating national guidelines are essential to further reduce morbidity and mortality of snakebite in Vietnam.

Perceived tuberculosis related stigma remains a critical structural barrier to timely healthcare-seeking and a major driver of the global tuberculosis burden. This study aimed to estimate the prevalence of perceived stigma and identify its associated factors among hospitalized pulmonary tuberculosis inpatients in Hue Central Hospital - a national tertiary hospital in Vietnam - in 2024. A mixed-methods design was employed, incorporating both quantitative and qualitative components. The quantitative component utilized the validated Van Rie Tuberculosis Stigma Scale (VTSS) with 200 pulmonary tuberculosis inpatients from May to July 2024 to measure multiple dimensions of perceived stigma. Additionally, 13 in-depth interviews were conducted with inpatients and healthcare workers following the quantitative phase. Quantitative data were analyzed using multivariable regression while qualitative data were audio-recorded, transcribed, thematically coded, and used to enrich interpretation of quantitative findings. Overall, 43.5% of inpatients experienced perceived stigma, 90.5% intentionally kept physical distance from others, and 87.0% disclosed their disease status selectively to close family members. Perceived stigma was more prevalent among patients with higher socioeconomic status (aOR = 2.01; 95%CI: 1.01-3.99), and those who were unmarried or widowed (aOR = 2.93; 95%CI: 1.01-8.47). Qualitative results further highlighted how social isolation, fear of contagion, and persistent cultural misconceptions about tuberculosis - compounded by the visibility of a tertiary hospital - significantly shaped these perceived stigmatizing experiences. Perceived pulmonary tuberculosis related stigma among pulmonary tuberculosis inpatients remains high. These findings underscore the urgent need for integrating stigma-reduction strategies into routine tuberculosis programs, including community education, patient-centered counselling, and strengthened social support mechanisms to mitigate the psychological burden of the disease.