A fast increase of municipal solid waste (MSW) has become the most concerning environmental problem in Vietnam, especially in the Mekong Delta region, that is considered one of the most vulnerable deltas to climate change in the world. There are 12 provinces and one central city in MD that occupy about 12% of the whole area of the nation with 5% of MSW generated. However, there is no currently effective management system in place for treatment and management of MSW in the MD. Landfill is the sole treatment option for MSW right now. With a low-level plain, MD is facing the most serious environmental problem in the near future with an effect of climate change and sea level rising. The landfill should not be considered for long-term use in this area. Suitable treatment options for MSW should be applied together with other solutions for reuse, recycling and reduction of MSW as well as pollution prevention issue. An integrated MSW management approach in adaptation to climate change is considered necessary.