Dr Mattias Larsson*

One evening, Hoa noticed that her one-month-old daughter Hiền felt hot, was unusually tired and was breastfeeding poorly. The next morning she took Hiền to a local clinic. After a brief examination without tests, the doctor diagnosed an ear infection and prescribed Augmentin. 

Hiền did not improve, and her fever rose. Hoa brought her to Family Medical Practice, where Hiền had received her first vaccinations. In a baby this young, fever is an emergency. On examination, her ears looked normal, but a urine test showed infection. A rapid test on the same sample detected ESBL, an enzyme that makes bacteria resistant to common antibiotics, including Augmentin. Within about 30 minutes, we had the diagnosis and knew which antibiotic would work.  

From large families to child survival 

In 1900, Sweden, the United States and Việt Nam were alike. Families were large, and losing a child was common. One child in six died before age five in Sweden, almost one in four in the US, and about four in ten in Việt Nam. 

By 1976, Sweden and the US had cut child deaths to 10 and 18 per 1,000. Việt Nam had just come through decades of war; women still had more than five children, and 76 of every 1,000 died before age five. 

That same year, Sweden and Việt Nam began their health collaboration with the construction of the Việt Nam–Sweden Hospital in Uông Bí. In 1981, the Việt Nam–Sweden Children’s Hospital opened in Hà Nội. The partnership later grew into our joint research on antibiotic resistance. 

Since then, Việt Nam has cut child deaths by more than three-quarters, to about 17 per 1,000, and families have about two children. That is where Sweden was in the early 1960s and the US in the mid-1970s, at a fraction of their income. Infant mortality in urban Việt Nam, about 7 per 1,000 births, is now lower than in several US states, including Mississippi (8.9) and Arkansas (8.2). 

Vaccines played a major part: from the mid-1980s, measles vaccine coverage in Việt Nam rose from under 5 per cent to almost 90 per cent in six years. Clean water, nutrition, mothers’ education and better treatment did the rest.

The next challenge: superbugs

Today, around half of child deaths occur in the first month of life, often from increasingly resistant infections. 

In the community, antibiotic use in children has decreased, yet resistance keeps rising. Multidrug resistance in pneumococci among rural children more than doubled between 1999 and 2014. 

In hospitals, the problem is greater. In a study across 12 Vietnamese hospitals, one in eight patients was already colonised on admission with carbapenem-resistant Enterobacterales (CRE), superbugs resistant to almost all antibiotics, including those of last resort. After two weeks in hospital, seven in eight were colonised. Among newborns with a hospital infection, more than half of those colonised with CRE died, twice as many as among those who were not colonised.  

We know what can work. In three paediatric intensive care units at the Việt Nam National Children’s Hospital, we introduced CRE screening on admission and separate care for colonised patients. The share of children who acquired CRE fell from 90 to 48 per cent, and fewer developed hospital infections. However, national health insurance does not yet reimburse screening, so hospitals or patients must pay, which makes wider implementation difficult.

Routine childhood vaccinations help protect children from preventable infections and reduce the need for treatment.

What parents can do 

Never give antibiotics without a doctor’s assessment; most childhood fevers are caused by viruses. 

Every sick child deserves a thorough examination and, when indicated, tests to confirm the diagnosis before treatment. Vaccinations prevent many infections that would otherwise need antibiotics. Family Medical Practice provides evidence-based care and the full range of childhood vaccines. 

Dr Mattias Larsson is a medical director and paediatrician at FMP Hanoi and an associate professor at Karolinska Institute and has a long experience in research on infectious diseases.

*Dr Mattias Larsson is Medical Director and Paediatrician at FMP Hanoi and an Associate Professor at Karolinska Institute and has a long experience in research on infectious diseases. He has worked with the Oxford University Clinical Research Unit and the Ministry of Health of Việt Nam. He is fluent in English, Swedish, Vietnamese, German and some Spanish.

FMP Healthcare Group operates medical centres in major cities including HCM City, Hà Nội and Đà Nẵng, offering consultations with international doctors, check-up centres and emergency ambulance services.

Visit FMP Hà Nội 24/7 at 298I Kim Mã Street, Ngọc Hà Ward, Hà Nội.

To book an appointment, please call us at (024).3843.0784, or contact us via WhatsApp, Viber or Zalo at +84.944.43.1919 or email hanoi@vietnammedicalpractice.com.