Thesis advisor: Seth Jacobs / Counterinsurgency doctrine, as an intellectual project, began as a response on the part of liberal world powers to the dual crises of decolonization and the Cold War. Unlike earlier means of suppressing rebellions, counterinsurgency sought not to quash, but to channel the revolutionary energies of decolonization into a liberal, developmentalist direction. Counterinsurgency would simultaneously defeat communists and build a new and better society. As early efforts at developmentalist counterinsurgency failed in Vietnam in the early 1960s, the counterinsurgent’s methods and goals changed. The CORDS Project, starting in 1967, replaced the emphasis on building a new society with altering present societies in such a way as to prioritize surveillance and the removal of subversive elements. From its inception, the political visions that counterinsurgency seeks to implement have shifted alongside – and at times prefigured – changes in liberal governance more broadly. / Thesis (PhD) — Boston College, 2018. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: History.

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According to the World Health Organization, over 200 infectious diseases in humans originate from animals (zoonoses), posing significant threats to human health. Zoonotic agents account for the majority of emerging and re-emerging pathogens. The human-animal interface has been recognised as an important risk factor that facilitates viruses to cross the species barrier and establish infection in humans. This indicates a need to perform surveillance of human populations who are at high risk of zoonotic infection due to their frequent contact with animals, together with the animals to which humans are exposed. The VIZIONS (Vietnam Initiative on Zoonotic Infections) has been conducted to directly respond to that need. The large virus family Picornaviridae include known emerging pathogens that have major impacts on the economies and human and animal health (e.g. foot-and-mouth disease virus, hand foot and mouth disease virus). Some enteroviruses (EVs) and parechoviruses in this family have been shown to be able to infect both humans and animals while a number of new picornaviruses (new EV variants, cosaviruses, cardioviruses, hunniviruses) with unknown pathogenicity and zoonotic potential have been discovered. This thesis, as part of VIZIONS, hopes to address the following gaps in our knowledge of such viruses in six genera (Enterovirus, Parechovirus, Cosavirus, Cardiovirus, Kobuvirus and Hunnivirus) of the family Picornaviridae: 1) The prevalence and genetic diversity of picornaviruses in studied samples 2) The epidemiology and disease association of the identified viruses 3) The overlaps (if any) of picornaviruses circulating in animals and humans 4) Possible animal sources of picornavirus infections in humans In order to do that, over 2,000 faecal samples collected from a wide range of hosts (pigs, rats, bamboo rats, shrews, bats, chickens, ducks, boars, civets, porcupines, monkeys and humans) were screened for picornaviruses by nested PCR and real-time PCR assays. Detection frequencies varied between viruses and sample origins with kobuvirus as the most commonly detected virus, followed by EV, cardiovirus and hunnivirus. Parechovirus and cosavirus were not detected. Comparison of detection frequencies of viruses infecting pigs revealed a disease (diarrhoea) association with porcine kobuvirus (PKV) but not EV infections. However, differences in PKV viral loads between diarrhoeic and non-diarrhoeic pigs were not statistically significant (p = 0.22). In addition, the PKV VP1 sequences from the two pig categories were not phylogenetically distinct. EV VP1 sequences obtained from pigs and boars showed high genetic diversity with four previously known types and nine new types (EV-G8 to -G16). Analyses of complete genome sequences of two new EV types provided evidence for inter-type recombination with a putative breakpoint in the 2A coding region. Similarly, study on samples from monkeys showed endemic infection of EV but no overlap with EV variants in humans was observed. The majority of EV detected in monkeys were novel with evidence for chimeric genomes and putative recombination breakpoints in the 2A region. New criteria for the classification of EV were additionally proposed. Characterization by sequencing of VP4/VP2 and VP1 regions or complete genomes of picornaviruses in rats and bamboo rats also showed relatively high genetic diversity. While these viruses can infect different species of rats, they were again genetically different from viruses detected in the studied human populations. In summary, studies in this thesis provide substantial new information on the prevalence, genetic diversity and disease association of picornaviruses in the studied populations. However, picornaviruses detected from animals were consistently separate from those found in humans, consistent with a relatively limited zoonotic potential of members of the virus family.

The Renovation Program - Ðổi Mới in Vietnam since 1986 have posed a puzzling policy question: why have some policy areas experienced radical changes while others have experienced only limited and incremental changes? This policy puzzle provided the focus for this dissertation in which a model of major policy change was developed to provide a new way of explaining the policy reforms in Vietnam over the past two decades. The model was developed based on three bodies of literature: (1) the most well-developed theories and models of policy change process created in the U.S and their application to the non-U.S policy contexts; (2) the Policy-elite model as an alternative to explain the policy reforms in developing countries; (3) critical and unique regime characteristics of Vietnam that play an important role in shaping the policy contexts for the policy processes and outcomes in Vietnam. Taken together, these bodies of literature provided the basic concepts and suggested potential causal mechanism of major policy change for a conceptual framework to build a major policy change model for Vietnam. The proposed policy model identifies four policy factors (stressor, leadership predisposition, change in policy image and consensus on the political priority) that need to occur at different stages of the policy process in Vietnam to make radical change happen. Owning to the unique regime characteristics of Vietnam, the model differs from other policy process theories and models in the way that it strongly emphasizes the role of the Communist Party and the predisposition to reform embraced by the policy elites in the process of major policy change. It also reflects the collective and consensus-based policy making style of the Vietnamese Communist Party and government in the transitional period of the country. The explanatory capacity of the proposed policy model was validated by four policy case studies in higher education, international trade liberalization, state economic sector, and legal reform in foreign investment in Vietnam. The empirical evidence drawn from the case studies has affirmed the usefulness and relevance of the policy factors and the causal flow embedded in the proposed model. Concretely, the two cases with radical policy changes witnessed the presence of all four policy factors and the processes of change followed the causal arguments of the model. Whereas, in the two cases without radical changes, the legacy of a Socialist state in Vietnam has impeded the significant changes in the policy image of the policy elites in respective policy domains. As the result, no innovative policy change alternative has been advanced to the agendas of the Vietnamese government, which in turn prohibited radical policy changes in the areas of higher education and state-owned enterprise over the past two decades. In the last chapter, the cross-case comparison has found that in all four cases, there have been strong stressors and the leaders of the Vietnamese Communist Party and government have felt great pressure to reform. The Party has shown the predisposition to reform in various guiding resolutions in the four policy sectors. Yet, in the cases of higher education policy on institutional autonomy and state-owned enterprise management policy, the lack of significant change in the policy image of the leaders has been the main reason for the absence of innovative policy change. In contrast, in the cases of international trade liberalization and legal reform in setting the level playing field for enterprises of all economic sectors, all the policy factors have occurred to produce radical policy changes in these two areas.

The overall objective of this thesis is to investigate factors that influence the utilization of maternal services, infant feeding and postpartum contraception practices in rural Vietnam. Field studies were carried out in a rural district of Thanh Hoa, a province located in North Central Vietnam. Willingness-to-pay for maternal preferences was measured in a sample of 200 postpartum and 196 pregnant women, as well as 196 men using the payment card technique. An association was found between satisfaction with the quality of maternal services and willingness-to-pay. There were no significant differences in willingness-to-pay values between prenatal and postpartum groups, and between male and female subjects. The feasibility, reliability and validity of a 20-item scale for measuring perceived quality of maternal services provided at commune health centres, were examined based on a sample of 200 postpartum and 196 pregnant women. The instrument was found to have good inter-rater reliability and internal consistency. Maternal status of clients (prenatal vs. postnatal) was found to influence the perceived quality of maternal services. Determinants of the utilization of maternal services at the primary health care level were investigated in a sample of 200 postpartum women together with sixteen focus group discussions and 16 in-depth interviews. The results showed that client-perceived quality of services and socio-cultural, and economic factors, rather than geographical access, could affect the utilization of maternal services. Factors affecting infant feeding practices were measured in a longitudinal study of 463 women at weeks one, 16 and 24 postpartum. Within the first week after delivery, the initiation and exclusive breastfeeding rates were relatively high at 98.3% and 83.6% respectively, but the premature introduction of complementary food was a great concern. / Exclusive breastfeeding dropped from 83.6% at week one to 43.6% at week 16, and by week 24, no infant was exclusively breastfed. Home-cooked solid food was introduced by 4.8%, 40.9% and 74.3% at weeks one, 16 and 24, respectively. Logistic regression analysis showed that, together with socio-cultural determinants, factors related to the mother, such as education level and occupation, and infant related factors could influence the initiation and exclusive breastfeeding within six months postpartum. The practice of contraceptive use within six months postpartum was also examined in a prospective study of 463 postpartum women. The proportion of contraceptive users at weeks 16 and 24 were 17.4% and 43.4% respectively. At week 24, of contraceptive users, 57.3% used IUD, 25.1% used condom, and 13.6% used traditional methods. Logistic regression analysis found age, sufficient knowledge on contraceptives and husband/partner opinion can significantly affect the contraception decision. The results of the study indicated that good physical access does not necessarily increase the utilization of maternal services due to institutional, environment and individual barriers. Client-perceived quality of services, socio-cultural and economic factors are important determinants of the utilization of maternal services. In view of the observed low rates of exclusive breastfeeding and contraception, there is a risk of unwanted pregnancy for women within six months postpartum. To improve maternal and child health status, health workers need to be trained in terms of inter-personal communication and counselling skills, and be appropriately supervised by district health authorities. Mobilizing the participation of the community and family, especially men to share the workload with women, would play a crucial role in the improvement of childbirth, contraception and breastfeeding practice.

It is arguable that at all times the long-term prosperity of a nation is inextricably linked to its educational system, especially of higher education. This study of Vietnam's educational structure and system is both unique and necessary. It provides detailed information and considerable analysis not previously available to readers outside Vietnam. As a historical study, it covers aspects of more than 2,000 years of the country's educational developments, from the invasion of China in 111 B.C. to the present. The study is divided into six chapters, each of which deals with a major period of time. Each chapter is self-contained. Historical background and essential materials are presented and analysed. The writing of historical events is based on chronological order. Vietnam was a country without written language before the coming of the Chinese who, in their invasion of Vietnam in 111 B.C., brought with them their civilization, culture, educational system and language. The introduction of Chinese language to Vietnam can be taken as the overture of Vietnamese education. The first two chapters provide detailed information and historical factors as to how an early educational system of Vietnam was established under the influence of China and through its impact of education on the formation of a Confucian political system and Confucian society, which continued to exist for over 2,000 years. The political decline of China in the late 19th century provided the opportunity for the French to enter Vietnam and finally replace the Chinese sovereignty over the country in 1885. The invasion and ruling of the French (1886-1954) brought forward significant changes in Vietnam politically, socially and educationally. / The French introduced a new, modem educational system to Vietnam and set up an elite colonial educational system which had a great impact on Vietnamese society as well as its education. Traditional Chinese education and its imperial examination system commenced to fade out in Vietnam from the early 20th century and came to an end in 1917. During this colonial period, Western ways of thinking and culture began to flow into Vietnam and continued thenceforth. With the division of the country into North and South as separate regimes under the Geneva Accords in 1954, the educational systems of each regime developed under different political systems and different ideologies from 1955-1975. In the North, the educational system was totally reformed according to Communist doctrine while in the South, education continued to develop in the Western ways. The world-known Vietnam War ended in April 1975. However, the unification of the North and South failed to be effected in many aspects due to varied ideologies and political systems. During the period of 1975-85 Vietnam underwent a transitional reform of education in the South, which continued up to the practice of the nation's `open-door policy' starting from 1987. Narration of a significant profile of attributes of Vietnam's system of education today is fully sketched. The concluding chapter comprises two major parts; the summing up and a general review on Vietnam's educational system and practices, together with some of the issues evident in the system at present.

The World Health Organization (WHO) has been implementing the Healthy Marketplace initiative in the market setting of developing countries since 1997. This initiative forms part of the Healthy Cities strategy and is reinforced through the Ottawa Charter for Health Promotion. The WHO Food Safety Division has indicated that every city in the WHO Healthy City program will eventually also have a Healthy Marketplace program. This is despite the absence of any published guidelines for facilitating program implementation, a clearly articulated Healthy Marketplace concept, and a dearth of meaningful program evaluations. This thesis set out to explore the views and experiences of in-country stakeholders involved in a Vietnamese Healthy Marketplace program. It also set out to examine the roles and perceptions of experts engaged in the design and delivery of programs across the developing world. Through an iterative and post-positivist research methodology, this inquiry collected and analysed data from five key sources: documents, detailed questionnaires, semi-structured interviews, and observations and reflections. The findings revealed that various and even conflicting program concepts and aims existed across and within groups, having significant implications for practice. The settings approach was not the dominant approach to health promotion in the Vietnamese market, but rather a 'top-down' topic-based approach dominated as the mechanism for program delivery. Consequently, numerous challenges have been identified for Healthy Marketplace policy and practice. The challenges are prefaced on the adoption of a settings approach, and include the need for : market communities to set their own agendas; the program target audience to be redefined; increased power sharing across stakeholders; the re-education of professionals; the sharing of knowledge; and the adequate resourcing of Healthy Marketplace programs / Master of Science (Hons)

Research Doctorate - Doctor of Philosophy (PhD) / Introduction: Surveillance data and other studies have indicated that the prevalence of overweight and obesity in preschool children in Ho Chi Minh City (HCMC) is increasing, particularly in urban areas. No studies have examined the speed at which this public health problem is emerging in child populations in urban Vietnam. Knowledge of the risk factors for preschool-aged child obesity is limited since earlier studies have been cross-sectional in design and potential risk factors at different levels have not been fully investigated. Objectives: This study aimed to assess the prevalence and trends in overweight and obesity, and to identify the risk factors associated with longitudinal changes in adiposity over a one year period in preschool children in urban areas of HCMC. In addition, a sub-study aimed to validate a proxy-questionnaire for use in measuring physical activity of preschool children. Method: Based on the available data from a cross-sectional study conducted with preschool children in HCMC in 2002, a restricted sample of 492 children aged four to five years from urban areas of HCMC was used for examining the trends in overweight and obesity in this child population, over the period from 2002 to 2005. The original study using the multi-stage cluster sampling was performed in preschool children aged one to six years in both urban and sub-urban areas of HCMC. A total of 1780 children aged one to six years participated in this study. Anthropometry of the subjects was measured using standard methods. Socio-demographic information was collected using a self-administered questionnaire. The one year follow-up study, using multi-stage cluster sampling, was conducted from 2005 to 2006 with children aged four to five years in preschools in urban areas of HCMC. At baseline, 670 children participated in the study and of these, 526 children completed two follow-up measurements at 6 month intervals. Information on neighbourhood, preschool and home environments, socio-economic status, the child’s and parental characteristics were collected using pre-coded, structured, interviewer-administered questionnaires. Dietary intake and physical activity were measured in the home and preschool settings using modified, validated questionnaires. Anthropometry including weight, height, skinfold thickness at triceps, subscapular and suprailiac sites were measured using standard methods. The trends in overweight and obesity were examined based on data from the 2002 study and the baseline study of the cohort study. Data were collected in 2002 and made available for these secondary analyses. The validation study of the proxy-questionnaire to measure physical activity of children aged four to five years was conducted from July, 2005 to November, 2005, using accelerometers as the criterion method. A subset of 83 children from the entire cohort study participated in this study. Physical activity data over the three months, reported by the teacher and the parents, were compared with data collected from the accelerometers for seven consecutive days. Main outcomes: Body mass index (BMI) was calculated from measured weight and height. Overweight and obesity were defined using IOTF cut-off points. Underweight was classified using the 5th percentile cut-off point for weight for age, based on the 2000 CDC Growth Reference. Results: The findings indicated that the significance of overweight and obesity in preschool children in urban areas of HCMC is not only in its magnitude (obverweight: 20.5% and obesity: 16.3% in 2005), but also in the rapidly increasing trend in prevalence from 21.4% in 2002 to 36.8% in 2005. There exists an imbalance in food intake in this young child population. Dietary patterns have shifted towards higher energy obtained from protein and fat (particularly animal protein and fat) and less energy from carbohydrates, than is recommended. The risk factors of overweight and obesity in the four to six year old child population in HCMC were identified at multiple levels. The contextual variables in the community, school and home environments, interacted with individual characteristics influencing the changes in adiposity and overweight and obesity development over time. Risk factors for changes in adiposity and risk of developing overweight and obesity differed for boys and girls. The proxy-questionnaire was shown to be valid for ranking the child’s sedentary behaviour but it was not suitable for measuring the child’s physical activity patterns in absolute values. Conclusion: An obesity epidemic has been taking place in the young child population in urban areas of HCMC. Boys appear to be more vulnerable to this epidemic than girls. The diet of this child population has shifted to higher energy from protein and fat, and less energy from carbohydrate. The aetiology of overweight and obesity of preschool children ismulti-factorial. It is time for action to control this public health problem in young children in urban areas of HCMC, Vietnam.

This thesis aims to study the development of the concept/model “the church as the family of God” and to explore its implications in terms of participation of church members and the social mission for the church in Vietnam. The discussion of the development of the ecclesiological concept helps to construct an ecclesiology of the church as the family of God in response to the call of Pope John Paul II in the Apostolic Exhortation Ecclesia in Africa (1995).It also assists the Vietnamese church in its evaluation and implication of the model of the church as family. This ecclesiological model has been promoted since the seventeenth century and emphasised since the Second Vatican Council in the church in Vietnam. The scope of this thesis studies the biblical, theological and ecclesiological development of the concept/model of the church as God’s family. It also investigates the understanding of the family and the church as family in Vietnam, the mutual relationships of church members and the characteristics of the mission of the church in the world. Then it explores the implications of the ecclesiology of the church as the family of God for the local church. A proper understanding of these issues is necessary because it helps the Vietnamese church to apply authentically the model of the church as the family of God. Chapter One discusses the biblical understanding of the family of God as the metaphor for the relationships between God and his people and among members in the church. The metaphor “the family/the household of God” was applied to the house church in early Christianity and provides some relevant implications for the church today. Chapter Two examines the theological foundations of the concept in patristic writings, in the liturgy and in church documents. Chapter Three explores the components of an ecclesiology of the church as the family of God which include trinitarian, Basic Ecclesial Communities, ancestral veneration and liberation ecclesiologies. Chapter Four investigates the traditional as well as modern Vietnamese family and its challenges in order to identify the foundation of the understanding of the concept of family in the local church. Chapter Five describes the development of the concept/model of the church as family in the organisation of the Vietnamese church that appeared in the seventeenth century and in some documents of the local church. Chapter Six analyses church hierarchy and the participation of the people of God. It provides some implications of the ecclesiology of the church as God’s family for the promotion of the participatory church in Vietnam. Chapter Seven examines the characteristics of and the practical tools in the church’s social mission and explores the challenges to the implications of the social mission of the church as the family of God. The conclusions of this thesis are that the concept/model and the applications of the church as the family of God have basic foundations in scripture, in patristic writings and in church documents. The concept of family in these materials implies two main meanings: the familial relationships between God and the people of God (or the church) and the mutual relationships among people in the church as well as in society. These relationships are based on human interactions in the family which are problematic in some situations. Therefore, the model of the church as family must be patterned on trinitarian communion of the divine family so that it can overcome the limitations of the human family. In that context, the Vietnamese family pointed out advantages as well as disadvantages in the development of the model of the church as family. The concept of family is very close to the Vietnamese; it provides some possibilities to develop the participation in the church and its mission in society. However, to some extent, the concept and the structure of the Vietnamese family which was influenced by Confucianism have challenged the local church in these areas. Therefore, the proper understanding of hierarchy and the church’s social mission were discussed. Based on that understanding some applications were also proposed in order to help the Vietnamese church to overcome these challenges and become an authentic model of the family of God.

Zugl.: Koblenz, Landau (Pfalz), Univ., Diss., 2007