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de Haan F, Amaratunga C, Thi VAC, Orng LH, Vonglokham M, Quang TN, Lek D, Boon WPC, Dondorp AM, Moors EHM. Strategies for deploying triple artemisinin-based combination therapy in the Greater Mekong Subregion. Malar J 2023; 22:261. [PMID: 37674172 PMCID: PMC10483751 DOI: 10.1186/s12936-023-04666-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/07/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND This is a qualitative study to identify implementation challenges for deploying triple artemisinin-based combination therapy (TACT) in the Greater Mekong Subregion (GMS) of Southeast Asia and to explore strategies to overcome these challenges. METHODS In-depth interviews were conducted in three countries that have repeatedly been confronted with ACT failures: Cambodia, Vietnam, and Lao PDR. Thirty-nine key stakeholders in the healthcare systems in these countries were interviewed. One participatory workshop was conducted in Cambodia, where scenarios for potential TACT deployment were discussed. RESULTS The results section is organized around four strategic themes that emerged from the data: policy support, data and evidence, logistics and operation, and downstream engagement. The study revealed that countries in the GMS currently rely on ACT to eliminate Plasmodium falciparum malaria by 2025. TACT is, however, considered to be a useful backup strategy in case of future treatment failures and to prevent the re-establishment of malaria. The study showed that a major challenge ahead is to engage decision makers and healthcare providers into deploying TACT, given the low case incidence of falciparum malaria in the GMS. Interview respondents were also skeptical whether healthcare providers would be willing to engage in new therapies for a disease they hardly encounter anymore. Hence, elaborate information dissemination strategies were considered appropriate and these strategies should especially target village malaria workers. Respondents proposed several regulatory and programmatic strategies to anticipate the formation of TACT markets in the GMS. These strategies include early dossier submission to streamline regulatory procedures, early stakeholder engagement strategies to shorten implementation timelines, and inclusion of TACT as second-line therapy to accelerate their introduction in case they are urgently needed. CONCLUSIONS This paper presents a qualitative study to identify implementation challenges for deploying TACT in the GMS and to explore strategies to overcome these challenges. The findings could benefit researchers and decision makers in strategizing towards potential future deployment of TACT in the GMS to combat artemisinin and partner drug resistance.
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Affiliation(s)
- Freek de Haan
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands.
| | - Chanaki Amaratunga
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Van Anh Cao Thi
- The University of North Carolina Project in Vietnam, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Long Heng Orng
- Mahidol Oxford Tropical Medicine Research Unit, Epidemiology Department, Mahidol University, Bangkok, Thailand
| | - Manithong Vonglokham
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane Capital, Lao PDR
| | - Thieu Nguyen Quang
- National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam
| | - Dysoley Lek
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Wouter P C Boon
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ellen H M Moors
- Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands
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Phonekeo S, Kounnavong S, Vonglokham M, Siengsounthone L, Homsana A, Gummin S, Vounatsu P, Nittiyanant P, Worawichawong S, Aekplakorn W, Odermatt P, Sayasone S. Intestinal helminth infections and associated risk factors among adults in the Lao People's Democratic Republic. Infect Dis Poverty 2023; 12:61. [PMID: 37386528 DOI: 10.1186/s40249-023-01112-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/02/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Helminthiases are highly endemic in Southeast Asia, including the Lao People's Democratic Republic (Lao PDR). This study aimed to assess the current intestinal helminth infections and the associated risk factors among adults across the Lao PDR. METHODS A cross-sectional survey was conducted in 165 villages across 17 provinces and the Vientiane Capital, Lao PDR. A multi-stage sampling method was employed to select the adult study participants (≥ 18 years). Data collection included (1) interview of the study participants, (2) physical measurements, and (3) a five gram of stool sample from each study participant was collected and preserved in 10% formalin solution for intestinal helminth detection using formalin-ether concentration technique (FECT). Descriptive analysis was used to describe the socio-demographic characteristics of study participants and the prevalence of intestinal helminth infections. Logistic regressions were applied to test the association between intestinal helminth infection and individual risk factors. A P-value below 0.05 was considered statistically significant. RESULTS A total of 2800 study participants were enrolled. Their average age was 46.0 years; 57.8% were female. Overall, 30.9%, 8.6% and 1.5% of study participants were infected with one, two, or three different intestinal helminth species, respectively. Among the study participants 21.6% were infected with hookworm, 18.8% with Opisthorchis viverrini-like (Ov-like) infection, 4.8% with Strongyloides stercoralis, 2.3% with Ascaris lumbricoides, 1.5% with Trichuris trichiura, and 3.3% with Taenia spp. Ov-like infection was of high prevalence in the southern (28.8%) and central (21.3%) provinces, while hookworm (26.3%), A. lumbricoides (7.3%), T. trichiura (3.1%), and Taenia spp. (4.2%) were prevalent in the northern provinces. Risk analysis showed that men were more likely to be infected with hookworm [adjusted odds ratio (aOR) = 1.2, P = 0.019]. The Lao-Tai ethnic group had a 5.2-times (P < 0.001) higher chance of having Ov-like infection than the minorities. Possession of toilet facility at home was associated with reduced odds for Ov-like (aOR = 0.4, P < 0.001) and hookworm (aOR = 0.6, P < 0.001) infections. CONCLUSIONS Our study provides a nationwide update of the intestinal helminth prevalence among adults in Lao PDR. To the best of our knowledge, this is the first Lao nationwide survey on intestinal helminth infections and risk factors in adults. It provides crucial information for national control programs for intestinal helminth infections in Lao PDR.
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Affiliation(s)
- Sengaloun Phonekeo
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Manithong Vonglokham
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Latsamy Siengsounthone
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Anousin Homsana
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People's Democratic Republic
- Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Sascha Gummin
- Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Penelope Vounatsu
- Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Prawat Nittiyanant
- Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Suchin Worawichawong
- Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Wichai Aekplakorn
- Department of Pathology, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Peter Odermatt
- Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Somphou Sayasone
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People's Democratic Republic.
- Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
- University of Basel, Basel, Switzerland.
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Kounnavong S, Vonglokham M, Sayasone S, Savathdy V, Masaki E, Kayano R, Phoummalaysith B, Boupha B, Hamajima N. Assessment of cognitive function among adults aged ≥ 60 years using the Revised Hasegawa Dementia Scale: cross-sectional study, Lao People's Democratic Republic. Health Res Policy Syst 2022; 20:121. [PMID: 36443883 PMCID: PMC9706827 DOI: 10.1186/s12961-022-00919-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Rapid population ageing remains an important concern for health, social and economics systems; thus, a broader assessment of cognitive decline among adults aged ≥ 60 years is essential. It is important to regularly collect reliable data through validated and affordable methods from people living in different areas and in different circumstances to better understand the significance of this health problem. This study aimed to identify the prevalence of cognitive impairment and the related risk factors by reassessing the scoring of the Revised Hasegawa Dementia Scale among older adults in the Lao People's Democratic Republic. METHODS A community-based cross-sectional investigation was conducted in rural and urban settings in six districts of three provinces in the country from January to July 2020. In total, 2206 individuals aged 60-98 years (1110 men and 1096 women) were interviewed in person using a pretested Lao version of the Revised Hasegawa Dementia Scale and the WHO STEPwise approach to noncommunicable disease (NCD) risk factor surveillance (the STEPS survey tool). The adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) were estimated using a logistic model. RESULTS The study found that 49.3% (1088/2206) of respondents (39.7% [441/1110] of men and 59.0% [647/1096] of women) had scores associated with some level of cognitive impairment. In addition to age, the following factors were significantly associated with cognitive impairment: having no formal education (AOR = 9.5; 95% CI: 5.4 to 16.8, relative to those with a university education), living in the northern region of the country (AOR = 1.4; 95% CI: 1.1 to 1.9, relative to living in the central region), living in a rural area (AOR = 1.5; 95% CI: 1.2 to 1.8), needing assistance with self-care (AOR = 1.8; 95% CI: 1.2 to 2.7) and being underweight (AOR = 1.5; 95% CI: 1.1 to 2.2). Factors associated with no cognitive impairment among older adults include engaging in moderate-intensity physical activity lasting for 10 minutes and up to 1 hour (AOR = 0.6; 95% CI: 0.5 to 0.8) and for > 1 hour (AOR = 0.6; 95% CI: 0.4 to 0.8). CONCLUSIONS Using the Lao version of the Revised Hasegawa Dementia Scale, this study found that more than half of adults aged ≥ 60 years had cognitive impairment, and this impairment was associated with several risk factors. The limitations of this study may include possible overdetection due to the cutoff point for the assessment of cognitive decline used in the Revised Hasegawa Dementia Scale, given that the participants were not familiar with the instrument. However, the study results can be used to help inform health policy in the Lao People's Democratic Republic regarding the urgent need for a routine data collection system and for providing an environment that addresses and reduces the identified risk factors for cognitive decline to mitigate their impact.
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Affiliation(s)
- Sengchanh Kounnavong
- grid.415768.90000 0004 8340 2282Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People’s Democratic Republic
| | - Manithong Vonglokham
- grid.415768.90000 0004 8340 2282Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People’s Democratic Republic
| | - Somphou Sayasone
- grid.415768.90000 0004 8340 2282Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People’s Democratic Republic
| | - Vanthanom Savathdy
- grid.415768.90000 0004 8340 2282Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People’s Democratic Republic
| | - Emiko Masaki
- The World Bank, Vientiane, Lao People’s Democratic Republic
| | - Ryoma Kayano
- Centre for Health Development, World Health Organization, Kobe, Japan
| | - Bounfeng Phoummalaysith
- grid.415768.90000 0004 8340 2282Ministry of Health, Vientiane, Lao People’s Democratic Republic
| | - Boungnong Boupha
- grid.415768.90000 0004 8340 2282Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People’s Democratic Republic
| | - Nobuyuki Hamajima
- grid.27476.300000 0001 0943 978XDepartment of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Kounnavong T, Vonglokham M, Moji K, Okumura J. Factors affecting alcohol drinking behaviour among secondary school students in Vientiane Province, Lao People's Democratic Republic: a cross-sectional study. Int Health 2022; 14:319-328. [PMID: 34403469 PMCID: PMC9070529 DOI: 10.1093/inthealth/ihab047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/05/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This study investigated alcohol consumption prevalence among adolescents in school settings in Lao People's Democratic Republic and identified factors associated with alcohol consumption to establish better school-based interventions. METHODS Self-administered questionnaires containing items assessing alcohol drinking behaviour and underlying factors were administered to 393 secondary school students ages 10-19 y. Multivariate logistic regression was used to predict factors associated with drinking behaviour. RESULTS Fifty-eight percent of respondents reported ever drinking alcohol. Among the drinkers, 52.6% were light drinkers, 16.8% were moderate drinkers, 27.0% were heavy drinkers and 3.5% were very heavy drinkers. Older age group (adjusted odds ratio [AOR] 5.2 [95% confidence interval {CI} 2.6 to 10.1]); peer pressure, particularly when more than two-thirds of friends drank alcohol (AOR 8.0 [95% CI 2.2 to 29.5]); and siblings' drinking behaviour (AOR 2.8 [95% CI 1.4 to 5.5]) were positively associated with alcohol use, while no permission to drink at home (AOR 0.2 [95% CI 0.1 to 0.6]), uncertain of permission to drink at home (AOR 0.06 [95% CI 0.02 to 0.1]) and never attempting to buy alcohol (AOR 0.2 [95% CI 0.1 to 0.4]) were negatively associated with respondents' alcohol use. CONCLUSIONS By the age of 19 y, most participating students had started drinking alcohol. One-third of them were permitted to drink by family members and drinking was strongly accelerated by peer pressure. Educational programmes are needed for adolescents attending school and their families that employ peer learning to raise awareness of the ill effects of alcohol use.
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Affiliation(s)
- Thidatheb Kounnavong
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki City 852-8523, Japan
| | - Manithong Vonglokham
- Department of Health System and Health Policy Research, Lao Tropical and Public Health Institute, Vientiane Capital, Lao PDR
| | - Kazuhiko Moji
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki City 852-8523, Japan
| | - Junko Okumura
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki City 852-8523, Japan
- Museum of Tropical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki City 852-8523, Japan
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Essink DR, Ratsavong K, Bally E, Fraser J, Xaypadith S, Vonglokham M, Broerse JE, Kounnavong S. Developing a national health research agenda for Lao PDR: prioritising the research needs of stakeholders. Glob Health Action 2021; 13:1777000. [PMID: 32741341 PMCID: PMC7480602 DOI: 10.1080/16549716.2020.1777000] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Currently the health research system in Lao PDR is fragmented and largely donor led.
Capacity among national public health institutes is limited to select priority research
questions for funding. Objective The objective of this capacity building and practice-oriented study is to describe the
process and outcome of the first National Health Research Agenda for Lao PDR and how the
agenda contributes to institutional capacity of the Ministry of Health, in order to
contribute to evidence-informed public health policy making. Method This activity used a mixed-methods approach. The overall design is based on principles
of the interactive Learning and Action approach and consists out of 6 phases: (1)
identification of needs, (2) shared analysis and integration, (3) nation-wide
prioritization of research domains, (4) exploring specific research questions, (5)
prioritization of research avenues, (6) dialogue and planning for action. The process
involved interviews with experts in health policy and research (n = 42), telephone-based
survey with district, provincial and national health staff (n = 135), a two-round Delphi
consultation with experts in health policy and research (n = 33), and a workshop with
policymakers, researchers, international organisations and civil society (n = 45) were
held to gather data and conduct shared analysis. Results 11 research domains were identified and prioritised: Health-seeking behaviour; Health
system research; Health service provision; Mother and child health (MCH); Sexual &
reproductive health; Health education; Non-communicable diseases (NCDs); Irrational drug
use; Communicable diseases (CDs); Road traffic accidents; Mental health. Within these
domains over 200 unique research questions were identified. Conclusion Our approach led to a comprehensive, inclusive, public health agenda for Lao PDR to
realise better informed health policies. Questions on the agenda are action-oriented,
originating in a desire to understand the problem so that immediate improvements can be
made. The agenda is used within the MoH as a tool to fund and approve research.
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Affiliation(s)
- Dirk R Essink
- Faculty of Science, Athena Institute , Amsterdam, Netherlands
| | - Kethmany Ratsavong
- Lao Tropical Institute and Public Health , Lao Peoples Democratic Republic
| | - Esmee Bally
- Faculty of Science, Athena Institute , Amsterdam, Netherlands
| | - Jessica Fraser
- Faculty of Science, Athena Institute , Amsterdam, Netherlands
| | - Sengdavy Xaypadith
- Department of Health Professional Education, Ministry of Health , Vientiane Capital, Vietnam
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Chaleunvong K, Phoummalaysith B, Phonvixay B, Vonglokham M, Sychareun V, Durham J, Essink D. Factors associated with patient payments exceeding National Health Insurance fees and out-of-pocket payments in Lao PDR. Glob Health Action 2020; 13:1791411. [PMID: 32741345 PMCID: PMC7480633 DOI: 10.1080/16549716.2020.1791411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 06/09/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Attaining universal health coverage is a target in the Sustainable Development Goals. In Lao PDR, to achieve universal health coverage, the government is implementing a national insurance scheme, initially targeting the informal sector. OBJECTIVE The purpose was to assess: i) the percentage of NHI patients who paid above the scheduled amount, based on individual billing payment; and ii) the factors related to overpayment. METHODS Descriptive cross-sectional study based on a structured questionnaire administered at health facilities in face-to-face interviews with 1,850 patients in six provinces. RESULTS All 1,850 participants worked in the informal sector. Of these, 78.8% of respondents (77.9% of in-patients; 79.5% of out-patients) made co-payments or were exempted from. Factors associated with in-patients paying above the scheduled fee were living in the province and district (OR = 2.8; 95%CI 1.2 to 6.3); not having documents with them (OR = 21.2; 95%CI 5.6 to 80.3); or not having documents (OR: 7.8; 95% CI 2.1 to 28.6). Significant factors associated with additional costs for out-patients were level of facility used at the provincial hospital (OR:1.4; 95% CI 1.1 to 1.9); older age (OR = 2.2; 95%CI 1.5 to 3.1); living in the province and district (OR = 2.3; 95%CI 1.5 to 3.7); living more than 5 km from the facility (OR = 1.4; 95%CI 1.1 to 1.9); buying medicine or supplies outside of the health facility (OR: 5.6; 95% CI 3.1 to 10.2); not bringing documents (OR:9.1; 95% CI 6.1 to 13.5), not having the right documents (OR: 8.9; 95% CI 5.4 to 14.8). CONCLUSIONS A number of patients paid above scheduled fee rates, which may deter people from utilising services when needing them. There is a need for increased understanding of the benefits of the national insurance scheme among patients and healthcare staff.
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Affiliation(s)
- Kongmany Chaleunvong
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao PDR
| | - Bounfeng Phoummalaysith
- Director General of the Lao National Health Insurance, Ministry of Health, Vientiane, Lao PDR
| | - Bouaphat Phonvixay
- Vice Director General of the Lao National Health Insurance, Ministry of Health, Vientiane, Lao PDR
| | | | | | - Jo Durham
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove QLD, Australia
| | - Dirk Essink
- Athena Institute, Faculty Science, VU University Amsterdam, Amsterdam, Netherlands
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Kounnavong S, Vonglokham M, Kounnavong T, Kwadwo DD, Essink DR. Anaemia among adolescents: assessing a public health concern in Lao PDR. Glob Health Action 2020; 13:1786997. [PMID: 32741354 PMCID: PMC7480417 DOI: 10.1080/16549716.2020.1786997] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/10/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Lao PDR has identified the need to target adolescent public health concerns. Adolescents suffering from poor health and nutrition during rapid growth and development may be at risk of anaemia due to high iron requirements and the rapid depletion of body iron stores. OBJECTIVE This study assessed the prevalence and severity of anaemia among school adolescents in Pholhong district, Vientiane province, Lao PDR. METHODS A school-based cross-sectional study was conducted among 405 randomly selected school adolescents across 8 high schools in a rural district of Vientiane province. Adolescents aged 10-18, both male and female, were recruited. Haemoglobin concentration from capillary blood was measured. Descriptive statistics were computed for prevalence of anaemia, anthropometric measurements, socio-economic and socio-demographic variables. Multivariate logistic regression analysis was performed to identify determinants of anaemia among subjects. Results were expressed as odds ratios and 95% confidence intervals. RESULTS The prevalence of anaemia among adolescents in the study area was 19.4%. There was no difference in the prevalence of anaemia between younger and older adolescents, but the prevalence of anaemia was higher in female adolescents than among males (crude OR = 3.91, 95% CI 2.20 to 6.96). On univariate analysis, coming from an ethnic minority household was found to be significantly associated with anaemia among these adolescents (p < 0.05). After adjusting for other variables, only the effect of sex remained significant. Other factors showing no significant association with anaemia included parents' employment status, family size, and living conditions. CONCLUSIONS The prevalence of anaemia in this population is of public health concern with adolescents of both sexes at risk of developing anaemia. The national nutrition programme to control and manage anaemia by distributing a weekly iron and folate supplement for adolescent girls together with a deworming programme twice per year appears to have partly successful but could be strengthened.
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Affiliation(s)
- Sengchanh Kounnavong
- Lao Tropical and Public Health institute, Ministry of Health, Lao People's Democratic Republic
| | - Manithong Vonglokham
- Lao Tropical and Public Health institute, Ministry of Health, Lao People's Democratic Republic
| | | | | | - Dirk R. Essink
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty Sciences, Vrije University Amsterdam, Amsterdam, Netherlands
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Keohavong B, Vonglokham M, Phoummalaysith B, Louangpradith V, Inthaphatha S, Kariya T, Saw YM, Yamamoto E, Hamajima N. Antibiotic prescription for under-fives with common cold or upper respiratory tract infection in Savannakhet Province, Lao PDR. Trop Med Health 2019; 47:16. [PMID: 30858755 PMCID: PMC6394019 DOI: 10.1186/s41182-019-0143-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 02/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background The irrational use of antibiotics has been identified as a major problem in healthcare, and it can lead to antimicrobial resistance, treatment failure, and increased healthcare costs. Although many studies worldwide have focused on the irrational use of drugs, reports on prescription practice in Lao PDR remained limited. This study aimed to examine the patterns of antibiotic prescription for under-fives with common cold or upper respiratory tract infection (URTI) at pediatric outpatient divisions. Methods One provincial hospital (PH) at Kaisone Phomvihane and four district hospitals (DHs) at Songkhone, Champhone, Atsaphangthong, and Xepon in Savannakhet Province were selected. Healthcare providers at these hospitals were interviewed and medical records of under-fives from 2016 were examined. Results Of the 54 healthcare providers interviewed, 85.2% had seen the standard treatment guideline, 77.8% adhered to this guideline, and 90.7% knew about antimicrobial resistance, while 18.5% participated in antimicrobial resistance activities. Medical records of 576 outpatients (311 boys and 265 girls) with common cold or URTI were examined, 154 at the PH and 422 at the DHs. Although antibiotics prescription proportions were similar between facilities at both levels (68.8% and 70.9% at the PH and DHs, respectively), antibiotics were exclusively prescribed for URTIs (96.4%), not for common cold (4.9%). First-line antibiotics recommended by WHO Model List of Essential Medicines for Children the 6th List were prescribed for 81.5% of patients; mainly, beta-lactam antibiotics were prescribed (87.2% of prescribed antibiotics). There were no cases in which two or more antibiotics were prescribed. The correct dose according to the National STG was 31.9% as a whole. The difference in the correct dose between the PH (52.8%) and the DHs (24.4%) was significant (p < 0.001). Conclusions This study demonstrated the patterns of antibiotic prescription for under-fives with common cold or URTI among healthcare providers from two different levels of facilities. Although an appropriate number of generic first-line antibiotics in the essential drug list were prescribed, the dosage and duration of antibiotic use were not appropriate. In order to further improve antibiotic prescription practices, regulation by the government is necessary; this could also decrease antimicrobial resistance and improve treatment outcomes.
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Affiliation(s)
- Bounxou Keohavong
- 1Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan.,2Food and Drug Department, Ministry of Health, Simuang road, Vientiane Capital, Lao People's Democratic Republic
| | - Manithong Vonglokham
- 3Lao Tropical and Public Health Institute, Ministry of Health, Vientiane Capital, Lao People's Democratic Republic
| | - Bounfeng Phoummalaysith
- 4National Health Insurance Bureau, Ministry of Health, Vientiane Capital, Lao People's Democratic Republic
| | - Viengsakhone Louangpradith
- 1Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan.,Mittaphab Hospital, Phonsavang V, Chanthabouly D, Vientiane Capital, Lao People's Democratic Republic
| | - Souphalak Inthaphatha
- 1Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
| | - Tetsuyoshi Kariya
- 1Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
| | - Yu Mon Saw
- 1Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
| | - Eiko Yamamoto
- 1Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
| | - Nobuyuki Hamajima
- 1Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
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Pengpid S, Vonglokham M, Kounnavong S, Sychareun V, Peltzer K. The Prevalence and Social Determinants of Fruit and Vegetable Consumption and Its Associations With Noncommunicable Diseases Risk Factors Among Adults in Laos. Asia Pac J Public Health 2019; 31:157-166. [PMID: 30854873 DOI: 10.1177/1010539519830824] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The study aimed to assess the prevalence and correlates of fruit and vegetable (FAV) consumption and its associations with noncommunicable diseases risk factors among adults in Laos. In a national cross-sectional survey in 2013, 2527 individuals (18-64 years old) responded to a questionnaire, and anthropometric and blood pressure measurements, and biochemistry tests were conducted. On average, participants had 0.99 servings of fruits a day and 1.33 servings of vegetables a day, a combined total of 2.32 servings of FAVs per day. Almost 1 in 5 respondents (18.9%) had 2 or more servings of fruit a day, 8.7% had 3 or more servings of vegetables a day, and 94.7% had less than 5 servings of FAV a day. In adjusted logistic analysis, being a Lao-Tai increased the odds of consuming 2 or more servings of fruits daily. Past month binge drinking decreased the odds of having 3 or more servings of vegetables daily. Higher education and urban residence decreased the odds of inadequate (<5 servings) FAV consumption. In adjusted linear regression analysis, increased FAV consumption was associated with higher body mass index scores. A high prevalence of inadequate FAV consumption was found. Interventions targeting identified modifiable risk factors, including lower education, general obesity, and binge drinking, may potentially increase FAV consumption in Laos.
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Affiliation(s)
- Supa Pengpid
- 1 Mahidol University, Salaya, Phutthamonthon, Nakhonpathom, Thailand.,2 University of Limpopo, Turfloop, South Africa
| | | | | | | | - Karl Peltzer
- 5 Department for Management of Science and Technology Development, Ton Duc Thang University, Ho Chi Minh City, Vietnam.,6 Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City, Vietnam
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10
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Pengpid S, Vonglokham M, Kounnavong S, Sychareun V, Peltzer K. The prevalence, awareness, treatment, and control of hypertension among adults: the first cross-sectional national population-based survey in Laos. Vasc Health Risk Manag 2019; 15:27-33. [PMID: 30881005 PMCID: PMC6398413 DOI: 10.2147/vhrm.s199178] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Aim The aim of this study was to determine the national prevalence of hypertension and its awareness, treatment, and control in Laos. Methods A national cross-sectional study was conducted in 2013. Using stratified cluster random sampling, 2,543 individuals aged 18–64 years were included from Laos. According to WHO STEPS methodology, questionnaire interview, anthropometric and blood pressure measurements, and biochemistry tests were conducted. Logistic regressions were used to estimate the determinants of hypertension (SBP [and/or DBP] ≥140 [90] mmHg or use of antihypertensive medications). Results Overall, 20.0% of the population had hypertension, 18.5% among men and 21.1% among women. Among hypertensives, 29.4% were aware, 18.2% were currently using antihypertensive medication, and 16.7% had controlled their blood pressure (<140 mmHg SBP and DBP <90 mmHg). In fully adjusted models in both men and women, older age and general obesity were positively associated with hypertension. In addition, among men having raised cholesterol and completed primary education, and among women central obesity and hazardous or harmful alcohol users were positively associated with hypertension. Conclusion The study found a significant prevalence of hypertension and low awareness, treatment, and control rates of hypertension among adults in Laos.
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Affiliation(s)
- Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Salaya, Nakhon Pathom, Thailand.,Office of the Deputy Vice Chancellor (Research and Innovation), North West University, Potchestroom, South Africa
| | - Manithong Vonglokham
- Department of Health Policy and Health System Research, Lao Tropical and Public Health Institute, Vientiane, Laos
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Vientiane, Laos.,Ministry of Health, Vientiane, Laos
| | - Vanphanom Sychareun
- Faculty of Postgraduate Studies, University of Health Sciences, Ministry of Health, Vientiane, Laos
| | - Karl Peltzer
- Department for Management of Science and Technology Development, Ton Duc Thang University, Ho Chi Minh City, Vietnam, .,Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City, Vietnam,
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11
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Vonglokham M, Kounnavong S, Sychareun V, Pengpid S, Peltzer K. Prevalence and social and health determinants of pre-diabetes and diabetes among adults in Laos: a cross-sectional national population-based survey, 2013. Trop Med Int Health 2018; 24:65-72. [PMID: 30303580 DOI: 10.1111/tmi.13164] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Diabetes is a major and fast-growing public health problem in Southeast Asia. We determined the prevalence of pre-diabetes and diabetes and assessed the levels of awareness, treatment and control in Lao People's Democratic Republic (PDR). METHODS A national cross-sectional study based on a stratified cluster random sampling was conducted in 2013. The sample comprised 2492 individuals aged 18-64 years (59.3% females; mean age 38.7 years, SD = 12.8) from Lao PDR. We followed the WHO STEPS method: step 1, questionnaire interview; step 2, anthropometric and Blood Pressure (BP) measurements; and step 3, biochemistry tests. Multinominal logistic regression was used to investigate the determinants of pre-diabetes and diabetes (fasting plasma glucose levels ≥ 7.0 mmol/L; or using insulin or oral hypoglycaemic drugs; or having a history of diagnosis of diabetes). RESULTS 5.7% of the population had diabetes, 4.7% of men and 6.4% of women, and 2.3% had pre-diabetes, 1.8% of men and 2.6% of women. Only 14.1% of the population sample indicated that they had ever their blood glucose measured by a health-care worker. This was higher in urban (20.9%) than rural (10.9%) dwellers (P < 0.001), and among female (16.6%) than male (10.5%) participants (P < 0.001). Among those with diabetes, 58.1% were aware of their diabetes status, 40.3% were taking treatment and 10.9% had controlled diabetes. The factor independently associated with impaired fasting glycaemia (IFG) or pre-diabetes was central obesity (Adjusted Relative Risk Ratio-ARRR: 3.92, Confidence Interval-CI: 1.89, 8.14) but none of the other health (general body weight, fruit and vegetable consumption, physical activity, substance use, hypertension and cholesterol) and sociodemographic (age, sex, education, employment status, marital status, ethno-linguistic group and residence status) variables. Factors independently associated with diabetes were older age (ARRR: 5.12, CI: 1.55, 10.20), central obesity (ARRR: 2.15, CI: 1.16, 4.00), low or moderate physical activity (ARRR: 0.75, CI: 0.60, 0.93), having hypertension (ARRR: 1.68, CI: 1.01, 2.83), and dyslipidaemia (ARRR: 1.75, CI: 1.08, 2.81). CONCLUSION A public health response is needed in the form of integrated and comprehensive action targeting major non-communicable diseases in the country.
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Affiliation(s)
| | | | - Vanphanom Sychareun
- Faculty of Postgraduate Studies, University of Health Sciences, Ministry of Health, Vientiane, Lao PDR
| | - Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhonpathom, Thailand.,Department of Research and Innovation, University of Limpopo, Turfloop, South Africa
| | - Karl Peltzer
- Department for Management of Science and Technology Development, Ton Duc Thang University, Ho Chi Minh City, Vietnam.,Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City, Vietnam
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12
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Ferguson EL, Watson L, Berger J, Chea M, Chittchang U, Fahmida U, Khov K, Kounnavong S, Le BM, Rojroongwasinkul N, Santika O, Sok S, Sok D, Do TT, Thi LT, Vonglokham M, Wieringa F, Wasantwisut E, Winichagoon P. Realistic Food-Based Approaches Alone May Not Ensure Dietary Adequacy for Women and Young Children in South-East Asia. Matern Child Health J 2018; 23:55-66. [DOI: 10.1007/s10995-018-2638-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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13
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Qian Y, Yan F, Wang W, Clancy S, Akkhavong K, Vonglokham M, Outhensackda S, Østbye T. Challenges for strengthening the health workforce in the Lao People's Democratic Republic: perspectives from key stakeholders. Hum Resour Health 2016; 14:72. [PMID: 27899109 PMCID: PMC5129208 DOI: 10.1186/s12960-016-0167-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 11/19/2016] [Indexed: 06/01/2023]
Abstract
BACKGROUND The Lao People's Democratic Republic is facing a critical shortage and maldistribution of health workers. Strengthening of the health workforce has been adopted as one of the five priorities of the National Health Sector Strategy (2013-2025). This study aims to identify, explore, and better understand the key challenges for strengthening the Laotian health workforce. METHODS This study applied exploratory and descriptive qualitative methods and adapted a working life-span framework. Twenty-three key stakeholders with particular insights into the current situation of the health workforce were purposively recruited for in-depth interviews. Important policy documents were also collected from key informants during the interviews. Thematic analysis was employed for the textual data using MAXQDA 10. RESULTS The overarching problem is that there is a perceived severe shortage of skilled health workers (doctors, nurses, and midwives) and lab technicians, especially in primary health facilities and rural areas. Key informants also identified five problems: insufficient production of health workers both in quantity and quality, a limited national budget to recruit enough health staff and provide sufficient and equitable salaries and incentives, limited management capacity, poor recruitment for work in rural areas, and lack of well-designed continuing education programs for professional development. These problems are interrelated, both in how the issues arise and in the effect they have on one another. CONCLUSIONS To improve the distribution of health workers in rural areas, strategies for increasing production and strengthening retention should be well integrated for better effectiveness. It is also essential to take the Laotian-specific context into consideration during intervention development and implementation. Furthermore, the government should acknowledge the inadequate health management capacity and invest to improve human resource management capacity at all levels. Finally, assessment of interventions for health workforce strengthening should be developed as early as possible to learn from the experiences and lessons in the Lao People's Democratic Republic.
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Affiliation(s)
- Yi Qian
- Department of Social Medicine, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai, 200032 People’s Republic of China
- Fudan Global Health Institute, Fudan University, Shanghai, 200032 People’s Republic of China
- Key Laboratory of Health Technology Assessment (Ministry of Health), Shanghai, 200032 People’s Republic of China
| | - Fei Yan
- Department of Social Medicine, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai, 200032 People’s Republic of China
- Fudan Global Health Institute, Fudan University, Shanghai, 200032 People’s Republic of China
| | - Wei Wang
- Department of Social Medicine, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai, 200032 People’s Republic of China
| | - Shayna Clancy
- Department of Community and Family Medicine, Duke University, Durham, NC United States of America
| | - Kongsap Akkhavong
- National Institute of Public Health, Vientiane Capital, Lao People’s Democratic Republic
| | - Manithong Vonglokham
- National Institute of Public Health, Vientiane Capital, Lao People’s Democratic Republic
| | - Somphou Outhensackda
- National Institute of Public Health, Vientiane Capital, Lao People’s Democratic Republic
| | - Truls Østbye
- Department of Community and Family Medicine, Duke University, Durham, NC United States of America
- Center for Aging Research and Education, Duke-NUS Medical School, Singapore, Singapore
- Duke Global Health Institute, Duke University, Durham, NC United States of America
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Patcharanarumol W, Siengsounthone L, Vonglokham M, Jacobs B, Tangcharoensathien V. Household costs associated with health care seeking at three tertiary care hospitals in Lao PDR. Southeast Asian J Trop Med Public Health 2012; 43:1521-1536. [PMID: 23413717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The objective of this study was to estimate household costs (direct medical, direct non-medical and opportunity costs) associated with outpatient consultations and inpatient admissions at three tertiary hospitals in Lao PDR (national, university and regional hospitals). Revolving drug funds are the main sources of revenue for the facilities. We used outpatient exit interviews and interviews with discharged inpatients to obtain data. A total of 280 outpatients and 149 patients discharged from internal medicine wards were interviewed. The average cost for the outpatient services was USD16.0 per patient. Direct medical costs accounted for more than half the amount. Patient interviews revealed it was common for the hospital to require patients to come back the following day to obtain the results of ancillary services which will result in higher transportation and opportunity costs to the patient. The average cost for inpatient admission was USD292; this ranged from USD118 (regional hospital) to USD407 (national hospital). Direct medical costs accounted for 60% and 35% at those two facilities, respectively. Revolving drug funds as a provider payment method at tertiary hospitals were regressive. An uninsured patient faced higher outpatient costs than an insured patient. With the limited number of people currently insured in Lao PDR (8% of the total population in 2009), these results suggest the need to rapidly scale up effective risk protection schemes.
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15
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Kounnavong S, Vonglokham M, Houamboun K, Odermatt P, Boupha B. Soil-transmitted helminth infections and risk factors in preschool children in southern rural Lao People's Democratic Republic. Trans R Soc Trop Med Hyg 2011; 105:160-6. [PMID: 21288547 DOI: 10.1016/j.trstmh.2010.11.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 11/17/2010] [Accepted: 11/19/2010] [Indexed: 02/02/2023] Open
Abstract
The current widespread school-based control of soil-transmitted helminth (STH) infections is also advocated for preschool children. The objective of this study was to assess infection with STHs as well as their determinants in preschool children (<60 months) in southern rural Lao People's Democratic Republic (Lao PDR). A cluster survey was carried out from October to December 2006 in three districts of Savannakhet Province. The prevalence of Ascaris lumbricoides, hookworm and Trichuris trichiura was 27.4% (95% CI 27.0-27.6%), 10.9% (95% CI 10.7-11.0%) and 10.9% (95% CI 10.7-11.1%), respectively. Of the children studied, 28.4% had a monoparasitic infection and 9.3% had a polyparasitic infection. Older children had a higher risk for hookworm infection [odds ratio (OR) = 1.75, 95% CI 1.03-3.01; P = 0.041] and multiple infections (OR = 1.81, 95% CI 1.01-3.20; P = 0.044). Low socioeconomic status was associated with A. lumbricoides (OR = 0.61, 95% CI 0.38-0.98; P = 0.043) and monoparasitic infections (OR = 0.62, 95% CI 0.38-0.99; P = 0.049). In Lao PDR, deworming of preschool children is warranted. Preventive measures should address important risk factors. Health education regarding personal hygiene, appropriate water management and the construction and proper use of latrines are additional essential elements.
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Affiliation(s)
- Sengchanh Kounnavong
- National Institute of Public Health, Ministry of Health, Vientiane, Lao People's Democratic Republic.
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