Transforming Antibiotic Stewardship at the Community Level: One Health in Action with Pediatric Caregivers in Vietnam

By Dr. Vu Thi Quynh Chi and Team 

Editor: Anti Rismayanti, SEAOHUN Regional Program Manager 

Antimicrobial resistance (AMR) is one of the most pressing health threats of our time—complex, multidimensional, and deeply rooted in human behavior. In Vietnam, AMR is particularly concerning among pediatric populations due to high rates of infectious disease and frequent antibiotic misuse. Recognizing this challenge, our team at The University of Danang launched a focused intervention under the SEAOHUN 2024 One Health Research and Training (OHRT) Awards Program, aimed at improving antibiotic knowledge and usage practices among caregivers of children under five years old.

The project, titled "Knowledge and Use of Antibiotics among Pediatric Caregivers: Comparing Two Educational Interventions," was designed to evaluate the effectiveness of one-on-one versus group education in promoting antibiotic stewardship through a One Health lens. The findings not only shed light on behavioral change potential but also demonstrate how tailored education at the community level can become a frontline defense against AMR.

Implementation Journey: Bridging Research, Education, and Community Needs

The intervention was implemented over five months at Da Nang Hospital for Women and Children. Sixty caregivers were enrolled and randomly divided into two groups: one receiving individualized education, and the other participating in group sessions. Educational content was informed by literature reviews and local needs, and covered proper antibiotic use, risks of resistance, and hygiene-based infection prevention. These sessions were complemented by pre- and post-training assessments using structured Vietnamese-language questionnaires to evaluate knowledge and behavior change.

Logistically, the project faced hurdles. Coordinating with caregivers whose time was constrained by family and work obligations proved difficult. In response, the team provided transportation stipends and scheduled training on weekends. Additionally, administrative bottlenecks at the hospital were alleviated through collaborative engagement with hospital leadership, easing access and data collection. These experiences underscore the importance of community-centric, flexible programming in public health initiatives.

Educational Interventions: Insights into Learning Dynamics

The comparative analysis between educational formats revealed a significant overall improvement across all participants. Knowledge scores jumped from a mean of 39.9 to 54.0 out of 60, while correct practices improved from 32.4 to 40.7 out of 45—both with statistical significance (p < 0.001). However, the depth of learning was notably different between formats.

Participants who received one-on-one education not only showed higher post-training scores, but also demonstrated more nuanced understanding. For example, they were significantly more likely to correctly state that antibiotics are ineffective for viral infections and that hot water can degrade reconstituted antibiotic suspensions. They also expressed greater confidence in safely administering pediatric medications.

In contrast, group sessions allowed for broader outreach and peer exchange but lacked the individualized attention needed to dismantle deep-rooted misconceptions. These insights affirm that while group education is practical for scale, one-on-one engagement is indispensable for lasting behavior change—especially in contexts where traditional beliefs and limited medical literacy influence health practices.

The One Health Perspective: Shifting Paradigms at the Grassroots Level

A central achievement of this project was translating the abstract concept of One Health into everyday relevance for caregivers. Many participants initially perceived antibiotic misuse as a personal or family issue. Through interactive sessions and tailored examples—such as how antibiotic-resistant bacteria can emerge from livestock and contaminate food or water—caregivers began to understand the interconnectedness of human, animal, and environmental health.

The project also introduced a Handbook on the Use of Antibiotics for Children, a practical resource developed by the team to reinforce lessons and serve as a reference for safe medication practices at home. With easy-to-read visuals and culturally appropriate language, the handbook has already begun to gain traction as a communication tool among local health workers.

Contributions to Faculty and One Health Education

The project also yielded transformative outcomes for the faculty involved. As educators at OHUN member universities, we gained firsthand experience in designing participatory learning tools, applying real-world scenarios, and measuring impact through rigorous evaluation. These insights have inspired curriculum reforms that integrate practical, community-based case studies and simulation exercises that mirror the realities of AMR and antibiotic misuse.

Beyond academia, the project has strengthened our network with hospital administrators, pharmacists, and public health officials—laying the groundwork for future cross-sector collaborations in One Health advocacy and training.

Envisioning Long-Term Impact and Scaling Up

Looking ahead, we anticipate the project will catalyze long-term change both in household health behaviors and institutional practices. The improved knowledge and skills of caregivers are expected to reduce unnecessary antibiotic use, leading to better child health outcomes and helping slow the spread of resistance. We are currently exploring opportunities to integrate this model into routine pediatric care, leveraging hospital and local government support.

Challenges remain: sustained funding, maintaining caregiver engagement, and translating educational success into systemic change. To address these, we aim to pursue support from governmental health agencies and international donors, while developing scalable, tech-enabled versions of the training, such as mobile health applications for caregiver education.

Advancing One Health in Vietnam: A Scalable, Sustainable Model

This initiative stands as a replicable model for One Health education in resource-constrained settings. By combining behavior change science, locally adapted materials, and flexible delivery methods, the project directly addresses one of the root causes of AMR: lack of public understanding and improper use of antibiotics. As Vietnam continues to battle high rates of resistance in pediatric and general populations, community-based interventions like this are essential complements to clinical and policy efforts.

Lessons Learned: Education with Empathy and Evidence

Throughout the course of the project, several key insights surfaced that can inform future initiatives aiming to foster behavior change through One Health education. One of the most important realizations was that behavioral change is deeply personal. The one-on-one interactions provided a safe, judgment-free space for caregivers to voice their concerns and clarify misconceptions—something that group settings often do not allow. This personalized approach fostered trust and encouraged honest dialogue, resulting in a deeper understanding of antibiotic use and resistance.

Another valuable lesson was the power of simplicity. Visual aids, relatable examples, and straightforward language proved highly effective in bridging the gap between complex scientific concepts and everyday caregiving practices. Many participants, previously unaware of the consequences of misuse, found clarity through these accessible tools.

Equally important was the recognition that health systems must prioritize listening. Caregivers consistently expressed appreciation for being seen and heard, especially when the training content was adapted to their schedules, responsibilities, and prior knowledge. This responsiveness made them more open to learning and adopting new practices.

Lastly, the project reinforced that change cannot be a one-time event. Sustained progress requires continuous engagement—through follow-up sessions, accessible resources, and community-level reinforcement of One Health messages. Only through repeated, consistent exposure can new habits be nurtured and old misconceptions dismantled.

Together, these lessons highlight the necessity of empathy, adaptability, and persistence in educational interventions. They offer a roadmap for educators, health professionals, and policymakers committed to advancing One Health in ways that are not only scientifically sound but also human-centered and culturally attuned.

Conclusion

The SEAOHUN OHRT Awards Program has empowered us to transform an abstract, global health challenge into a locally actionable program. Our journey with pediatric caregivers in Danang demonstrates that meaningful change starts with informed individuals—and that with the right tools, trust, and training, even small-scale interventions can ripple into systemic impact. Through a One Health lens, we have not only improved antibiotic stewardship in one community but helped lay the foundation for a healthier, more resilient Vietnam.

Team Leader: Dr. Vu Thi Quynh Chi, The University of Danang

Team Members: Van Pham Kim Thuong, Tran Thi Van, The University of Danang