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Sekiya S, Masuoka H, Mizuno Y, Kibe M, Kosaka S, Natsuhara K, Hirayama K, Inthavong N, Kounnavong S, Tomita S, Takayasu L, Suda W, Yagyu F, Umezaki M. Asymptomatic Enteric Virus Infections and Association with the Gut Microbiome in Rural Residents of Northern Laos. Am J Trop Med Hyg 2024; 110:759-767. [PMID: 38471149 PMCID: PMC10993851 DOI: 10.4269/ajtmh.23-0209] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 12/03/2023] [Indexed: 03/14/2024] Open
Abstract
Viral gastrointestinal infections are an important public health concern, and the occurrence of asymptomatic enteric virus infections makes it difficult to prevent and control their spread. This study aimed to determine the prevalence of and factors associated with asymptomatic enteric virus infection in adults in northern Laos. Fecal samples were collected from apparently healthy participants who did not report diarrhea or high fever at the time of the survey in northern Laos, and enteric viruses were detected using polymerase chain reaction (PCR) and reverse transcription (RT)-PCR. Individual characteristics, including the gut microbiome, were compared between asymptomatic carriers and noncarriers of each enteric virus. Of the participants (N = 255), 12 (4.7%) were positive for norovirus genogroup I (GI), 8 (3.1%) for human adenovirus, and 1 (0.4%) for norovirus GII; prevalence tended to be higher in less-modernized villages. Gut microbial diversity (evaluated by the number of operational taxonomic units) was higher in asymptomatic carriers of norovirus GI or human adenovirus than in their noncarriers. Gut microbiome compositions differed significantly between asymptomatic carriers and noncarriers of norovirus GI or human adenovirus (permutational analysis of variance, P <0.05). These findings imply an association between asymptomatic enteric virus infection and modernization and/or the gut microbiome in northern Laos.
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Affiliation(s)
- Sae Sekiya
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Masuoka
- Laboratory for Microbiome Science, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Yuki Mizuno
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mihoko Kibe
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoko Kosaka
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Kazuhiro Hirayama
- Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Nouhak Inthavong
- Ministry of Health, Lao Tropical and Public Health Institute, Vientiane, Laos
| | | | - Shinsuke Tomita
- Graduate School of Environmental Studies, Nagoya University, Nagoya, Japan
| | - Lena Takayasu
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Wataru Suda
- Laboratory for Microbiome Science, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Fumihiro Yagyu
- Graduate School of International Development and Cooperation, Kibi International University, Hyogo, Japan
| | - Masahiro Umezaki
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Aryal A, Clarke-Deelder E, Phommalangsy S, Kounnavong S, Fink G. Health system utilization and perceived quality among adults in Lao PDR: evidence from a nationally representative phone survey. BMC Public Health 2024; 24:565. [PMID: 38388912 PMCID: PMC10882776 DOI: 10.1186/s12889-024-18039-2] [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: 08/03/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The World Health Organization (WHO) defines quality health services as being effective, safe, people-centered, timely, equitable, integrated and efficient. It is critical to understand people's perspectives and care experiences to measure progress against these goals. However, many low- and middle-income governments do not routinely collect such information. In this study, we aim to measure health systems performance from the perspective of the adult population of users and non-users in Lao PDR. METHODS Using the People's Voice Survey (PVS), a novel phone-based survey designed to integrate people's voices into primary care performance measurement, we conducted a cross-sectional survey of the general adult (18+) population in Lao PDR in 2022. We analyzed health care utilization patterns, user-reported quality of care, and coverage of key preventive health services. Data from the most recent MICS survey was used to create sampling weights generating nationally representative estimates. RESULTS A total of 2007 adults completed interviews in approximately 3.5 months. About two thirds (65%) of respondents reported visiting a health facility in the past year and, of these, the majority (61%) visited a hospital as opposed to a health center or clinic. Among those that recently visited health facilities, 28% rated their experience as "poor" or "fair". 16% had unmet need for care and 12% reported discrimination during treatment in the past year. 12% of women over 50 years old reported receiving a mammogram and 59% of adults reported receiving blood pressure screening in the previous year. CONCLUSIONS The study presents data from the first nationally representative survey in Lao PDR to measure health system performance. The results indicate that, despite progress towards universal coverage of health insurance in Lao PDR, significant gaps remain, particularly with respect to bypassing of primary care facilities, significant unmet need for care, experiences of discrimination, and overall low perceptions of quality of care.
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Affiliation(s)
- Amit Aryal
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Emma Clarke-Deelder
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | - Günther Fink
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Smith TJ, Arnold CD, Fischer PR, Trehan I, Hiffler L, Sitthideth D, Stein-Wexler R, Yeh J, Jones KS, Hampel D, Tancredi DJ, Schick MA, McBeth CN, Tan X, Allen LH, Sayasone S, Kounnavong S, Hess SY. A Predictive Model for Thiamine Responsive Disorders among Infants and Young Children: Results from a Prospective Cohort Study in Lao People's Democratic Republic. J Pediatr 2024:113961. [PMID: 38369233 DOI: 10.1016/j.jpeds.2024.113961] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/12/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To develop a predictive model for thiamine responsive disorders (TRD) among infants and young children hospitalized with signs or symptoms suggestive of thiamine deficiency disorders (TDD) based on response to therapeutic thiamine in a high-risk setting. STUDY DESIGN Children aged 21 days to <18 months hospitalized with signs or symptoms suggestive of TDD in northern Lao PDR were treated with parenteral thiamine (100mg daily) for ≥3 days in addition to routine care. Physical examinations and recovery assessments were conducted frequently for 72 hours after thiamine was initiated. Individual case reports were independently reviewed by three pediatricians who assigned a TRD status (TRD or non-TRD), which served as the dependent variable in logistic regression models to identify predictors of TRD. Model performance was quantified by empirical area under the receiver operating characteristic curve (AUROC). RESULTS 449 children (median [Q1, Q3] 2.9 [1.7, 5.7] months old; 70.3% exclusively/predominantly breastfed) were enrolled; 60.8% had a TRD. Among 52 candidate variables, those most predictive of TRD were exclusive/predominant breastfeeding, hoarse voice/loss of voice, cyanosis, no eye contact and no diarrhea in the previous 2 weeks. The AUROC (95% CI) was 0.82 (0.78, 0.86). CONCLUSIONS In this study, the majority of children with signs or symptoms of TDD responded favorably to thiamine. While five specific features were predictive of TRD, the high prevalence of TRD suggests that thiamine should be administered to all infants and children presenting with any signs or symptoms consistent with TDD in similar high-risk settings. The usefulness of the predictive model in other contexts warrants further exploration and refinement.
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Affiliation(s)
- Taryn J Smith
- Institute for Global Nutrition, University of California Davis, Davis, California, USA;.
| | - Charles D Arnold
- Institute for Global Nutrition, University of California Davis, Davis, California, USA
| | - Philip R Fischer
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA;; Pediatrics Department, Sheikh Shakhbout Medical City, Abu Dhabi, UAE;; Khalifa University, Abu Dhabi, UAE
| | - Indi Trehan
- Departments of Pediatrics, Global Health, and Epidemiology, University of Washington, Seattle, Washington, USA;; Lao Friends Hospital for Children, Luang Prabang, Lao PDR
| | | | - Dalaphone Sitthideth
- Lao Tropical and Public Health Institute, Vientiane Capital, Lao People's Democratic Republic
| | - Rebecca Stein-Wexler
- Department of Radiology, University of California Davis Health System, Sacramento, California, USA
| | - Jay Yeh
- Department of Pediatrics, Division of Cardiology, University of California Davis Health System, Sacramento, California, USA
| | - Kerry S Jones
- Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Daniela Hampel
- Institute for Global Nutrition, University of California Davis, Davis, California, USA;; USDA-Agricultural Research Service Western Human Nutrition Research Center, Davis, California, USA
| | - Daniel J Tancredi
- Department of Pediatrics, University of California Davis Health System, Sacramento, California, USA
| | - Michael A Schick
- Emergency Medicine, University of California Davis Health System, Sacramento, California, USA
| | - Christine N McBeth
- Emergency Medicine, University of California Davis Health System, Sacramento, California, USA
| | - Xiuping Tan
- Institute for Global Nutrition, University of California Davis, Davis, California, USA
| | - Lindsay H Allen
- Institute for Global Nutrition, University of California Davis, Davis, California, USA;; USDA-Agricultural Research Service Western Human Nutrition Research Center, Davis, California, USA
| | - Somphou Sayasone
- Lao Tropical and Public Health Institute, Vientiane Capital, Lao People's Democratic Republic
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Vientiane Capital, Lao People's Democratic Republic
| | - Sonja Y Hess
- Institute for Global Nutrition, University of California Davis, Davis, California, USA
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Liverani M, Phongluxa K, Phommasone K, Chew R, Chandna A, Pongvongsa T, Mayxay M, Kounnavong S, Ashley E, Lubell Y. Prospects for the development of community-based care in remote rural areas: a stakeholder analysis in Laos. BMC Health Serv Res 2024; 24:55. [PMID: 38212788 PMCID: PMC10782664 DOI: 10.1186/s12913-023-10523-6] [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: 05/31/2023] [Accepted: 12/23/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Community-based health programmes have been a cornerstone of primary care in Laos for decades. The study presented here aimed to document prospects for the development of current programmes, considering perceptions about health and health care priorities in the communities, implementation challenges, the policy landscape and opportunities associated with the availability of new technologies. METHODS The research design primarily involved qualitative in-depth interviews with stakeholders (n = 35) responsible for the planning, management, or implementation of community-based care in Laos at different levels of the health system. These included health managers at central departments or institutes of the Ministry of Health, provincial health departments, district health offices, heads of health centres, village health volunteers, community representatives, and international stakeholders. RESULTS There was consensus that service delivery is still a challenge in many areas, due to geographic inaccessibility of health facilities, communication barriers, health-seeking behaviour, trust, and gender discrimination, particularly among ethnic minorities. In these settings, community health workers have the potential to extend the reach of the formal health system, acting as cultural brokers across sectors of society, ethnicities, and worldviews. To maximise impact, planners need to carefully consider the implementation model, financing arrangements, health system integration, and changing health priorities in the communities. CONCLUSIONS This study examined challenges to, and opportunities for, the expansion and health system integration of community-based care in Laos. Further development and horizontal integration of community-based care remains a complex financing and governance challenge, although the renewed emphasis on primary care and the ongoing process of decentralisation provide a favourable policy environment in the country to sustain and potentially expand existing programmes.
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Affiliation(s)
- Marco Liverani
- London School of Hygiene and Tropical Medicine, London, UK.
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
- Faculty of Public Health, Mahidol University, Bangkok, Thailand.
| | - Khampheng Phongluxa
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Koukeo Phommasone
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Vientiane, Lao People's Democratic Republic
| | - Rusheng Chew
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Arjun Chandna
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | | | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Vientiane, Lao People's Democratic Republic
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Institute of Research and Education Development, University of Health Sciences, 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
| | - Elizabeth Ashley
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Vientiane, Lao People's Democratic Republic
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Yoel Lubell
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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Hess SY, Smith TJ, Sitthideth D, Arnold CD, Tan X, Jones KS, Brown KH, Alayon S, Kounnavong S. Risk factors for anaemia among women and their young children hospitalised with suspected thiamine deficiency in northern Lao PDR. Matern Child Nutr 2024; 20:e13565. [PMID: 37803889 PMCID: PMC10749997 DOI: 10.1111/mcn.13565] [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] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/17/2023] [Accepted: 09/05/2023] [Indexed: 10/08/2023]
Abstract
Anaemia among women and young children remains a major public health concern. This secondary study describes the anaemia prevalence among young hospitalised children and their mothers in northern Lao People's Democratic Republic and explores possible nutritional causes and risk factors for anaemia. Hospitalised children (ages 21 days to <18 months) with clinical symptoms suggestive of thiamine deficiency disorders were eligible along with their mothers. Venous blood was collected for determination of haemoglobin, ferritin, soluble transferrin receptor (sTfR), retinol-binding protein (RBP), erythrocyte glutathione reductase activation coefficient (EGRac), thiamine diphosphate (ThDP) and acute phase proteins. Risk factors for anaemia were modelled using minimally adjusted logistic regression controlling for age. Haemoglobin results were available for 436 women (mean ± SD age 24.7 ± 6.4 years; 1.6% pregnant) and 427 children (4.3 ± 3.5 months; 60.3% male). Anaemia prevalence (Hb < 120 g/L for nonpregnant women and <110 g/L for pregnant women and children) was 30.7% among women and 55.2% among children. In bivariate analyses, biomarkers significantly associated with anaemia in women were ferritin, sTfR, RBP, EGRac and ThDP. Other risk factors for women were lower BMI, mid-upper arm circumference < 23.5 cm, lower education, lower socioeconomic index, food insecurity, Hmong ethnicity, not/rarely having attended antenatal care, not having taken antenatal iron-containing supplements and not meeting minimum dietary diversity. Risk factors for anaemia among children were older age, male sex, stunting, sTfR, ThDP and alpha-1-acid-glycoprotein. Anaemia was common among women and their hospitalised children and was associated with micronutrient deficiencies and socioeconomic, dietary and health care-seeking risk factors, suggesting that multiple strategies are required to prevent anaemia among women and children.
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Affiliation(s)
- Sonja Y. Hess
- Institute for Global Nutrition and Department of NutritionUniversity of California DavisDavisCaliforniaUSA
| | - Taryn J. Smith
- Institute for Global Nutrition and Department of NutritionUniversity of California DavisDavisCaliforniaUSA
| | - Dalaphone Sitthideth
- Lao Tropical and Public Health InstituteVientianeLao People's Democratic Republic
| | - Charles D. Arnold
- Institute for Global Nutrition and Department of NutritionUniversity of California DavisDavisCaliforniaUSA
| | - Xiuping Tan
- Institute for Global Nutrition and Department of NutritionUniversity of California DavisDavisCaliforniaUSA
| | - Kerry S. Jones
- Nutritional Biomarker Laboratory, MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - Kenneth H. Brown
- Institute for Global Nutrition and Department of NutritionUniversity of California DavisDavisCaliforniaUSA
| | - Silvia Alayon
- USAID Advancing NutritionArlingtonVirginiaUSA
- Save the ChildrenWashingtonWashington, D.C.USA
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health InstituteVientianeLao People's Democratic Republic
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Arsenault C, Lewis TP, Kapoor NR, Okiro EA, Leslie HH, Armeni P, Jarhyan P, Doubova SV, Wright KD, Aryal A, Kounnavong S, Mohan S, Odipo E, Lee HY, Shin J, Ayele W, Medina-Ranilla J, Espinoza-Pajuelo L, Derseh Mebratie A, García Elorrio E, Mazzoni A, Oh J, SteelFisher GK, Tarricone R, Kruk ME. Health system quality and COVID-19 vaccination: a cross-sectional analysis in 14 countries. Lancet Glob Health 2024; 12:e156-e165. [PMID: 38096888 PMCID: PMC10716622 DOI: 10.1016/s2214-109x(23)00490-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/12/2023] [Accepted: 10/10/2023] [Indexed: 12/17/2023]
Abstract
The social and behavioural determinants of COVID-19 vaccination have been described previously. However, little is known about how vaccinated people use and rate their health system. We used surveys conducted in 14 countries to study the health system correlates of COVID-19 vaccination. Country-specific logistic regression models were adjusted for respondent age, education, income, chronic illness, history of COVID-19, urban residence, and minority ethnic, racial, or linguistic group. Estimates were summarised across countries using random effects meta-analysis. Vaccination coverage with at least two or three doses ranged from 29% in India to 85% in Peru. Greater health-care use, having a regular and high-quality provider, and receiving other preventive health services were positively associated with vaccination. Confidence in the health system and government also increased the odds of vaccination. By contrast, having unmet health-care needs or experiencing discrimination or a medical mistake decreased the odds of vaccination. Associations between health system predictors and vaccination tended to be stronger in high-income countries and in countries with the most COVID-19-related deaths. Access to quality health systems might affect vaccine decisions. Building strong primary care systems and ensuring a baseline level of quality that is affordable for all should be central to pandemic preparedness strategies.
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Affiliation(s)
- Catherine Arsenault
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington DC, USA.
| | - Todd P Lewis
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Neena R Kapoor
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Emelda A Okiro
- Population & Health Impact Surveillance Group, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
| | - Hannah H Leslie
- Division of Prevention Science, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Patrizio Armeni
- CERGAS SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | | | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Katherine D Wright
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Amit Aryal
- Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland
| | | | - Sailesh Mohan
- Public Health Foundation of India, Gurgaon, Haryana, India
| | - Emily Odipo
- Population & Health Impact Surveillance Group, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
| | - Hwa-Young Lee
- Graduate School of Public Health and Healthcare Management, The Catholic University of Korea, Seoul, South Korea
| | - Jeonghyun Shin
- Department of Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Wondimu Ayele
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jesús Medina-Ranilla
- Faculty of Public Health and Administration, Epidemiology Department, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Laura Espinoza-Pajuelo
- Faculty of Public Health and Administration, Epidemiology Department, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Agustina Mazzoni
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Juhwan Oh
- Department of Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Gillian K SteelFisher
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Rosanna Tarricone
- CERGAS SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
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7
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Kibe M, Mizuno Y, Masuoka H, Kosaka S, Natsuhara K, Hirayama K, Inthavong N, Kounnavong S, Tomita S, Umezaki M. Transition to a market economy and chronic psychosocial stress in northern Laos: An exploratory study of urinary free cortisol in rural residents. Am J Hum Biol 2024; 36:e23976. [PMID: 37577830 DOI: 10.1002/ajhb.23976] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/15/2023] Open
Abstract
OBJECTIVES The indigenous population in northern Laos has experienced a transition from self-sufficiency to a market-oriented economy, which may have brought about unprecedented chronic psychosocial stress. This study examined the association between the transition to a market economy and urinary free cortisol (UFC) concentration as a stress biomarker among rural residents of three villages with different degrees of integration into the market economy. METHODS An interview survey and urine sample collection were conducted in August 2018 and March 2019. We measured the UFC concentration in spot urine samples collected in the morning from participants aged 20-60 years (n = 168) using an enzyme-linked immunosorbent assay. Multiple linear regression analysis was performed to examine differences in UFC concentrations among villages by sex, with time of arrival for the survey, age, and body mass index included as covariates. RESULTS The UFC concentration was higher in men living in the village with the highest degree of integration into the market economy than in those in the two villages with a lower dependence on cash, possibly linking increased stress levels with a change in employment type. This trend was not observed in women. CONCLUSION Socioeconomic changes incidental to a transition to a market economy may increase the stress levels of men in northern Laos.
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Affiliation(s)
- Mihoko Kibe
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuki Mizuno
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Masuoka
- Laboratory for Microbiome Sciences, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Satoko Kosaka
- Department of Public Health & Nursing, Nagasaki University, Nagasaki, Japan
| | | | - Kazuhiro Hirayama
- Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Nouhak Inthavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Laos
| | | | - Shinsuke Tomita
- Graduate School of Environmental Studies, Nagoya University, Nagoya, Japan
| | - Masahiro Umezaki
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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8
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Huang S, Conkle J, Homer CSE, Kounnavong S, Phongluxa K, Vogel JP. Comparing the accuracy of an ultrasound height measurement device with a wooden measurement board among children aged 2-5 years in rural Lao People's Democratic Republic: A methods-comparison study. PLoS One 2023; 18:e0289514. [PMID: 37976269 PMCID: PMC10656007 DOI: 10.1371/journal.pone.0289514] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Height is a key component of nutrition assessments in children from limited-resource settings. This study aimed to assess whether handheld digital ultrasound devices for measuring children's height provide comparable accuracy to traditional measurement boards, which are bulky and difficult to transport. METHODS We trained 12 health workers to measure the standing height of 222 children aged 2-5 years in rural Lao People's Democratic Republic using both the ultrasound device and measurement board. The Bland-Altman method was used to depict limits of agreement and potential bias. We reported the technical error of measurement (TEM) for precision and accuracy, then assessed these results against the Standardized Monitoring and Assessment for Relief and Transition (SMART) Manual 2.0 and the WHO Multicentre Growth Reference Study (MGRS). RESULTS The average difference between the ultrasound and board measurements was 0.096 cm (95% limits-of-agreement: 0.041cm, 0.61cm) with a systematic bias of 0.1cm (95% confidence interval: 0.067cm, 0.134cm), suggesting the ultrasound measurements were slightly higher than those from the board. The ultrasound and board TEMs for precision were 0.157cm and 0.091cm respectively. The accuracy TEM was 0.205cm. All TEMs were within SMART and WHO MGRS limits. CONCLUSION The ultrasound device is comparable to the measurement board among standing Lao children aged 2-5 years for precision and accuracy TEMs but showed a bias of 0.1cm. Further studies are required to assess whether calibration can minimise this bias and determine the ultrasound's accuracy on recumbent length for infants and younger children.
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Affiliation(s)
- Shan Huang
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Department of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Joel Conkle
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York, New York, United States of America
| | - Caroline S. E. Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Department of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao PDR
| | - Khampheng Phongluxa
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao PDR
| | - Joshua P. Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Department of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
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Ahissou NCA, Nonaka D, Takeuchi R, de Los Reyes C, Uehara M, Khampheng P, Kounnavong S, Kobayashi J. Trend of sociodemographic and economic inequalities in the use of maternal health services in Lao People's Democratic Republic from 2006 to 2017: MICS data analysis. Trop Med Health 2023; 51:56. [PMID: 37858190 PMCID: PMC10585846 DOI: 10.1186/s41182-023-00548-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/07/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Maternal mortalities remain high in the Lao People's Democratic Republic (Lao PDR). Since 2012, to improve access to maternal health services for all women, the country implemented several policies and strategies including user fee removal interventions for childbirth-related care. However, it remains unclear whether inequalities in access to services have reduced in the post-2012 period compared to pre-2012. Our study compared the change in sociodemographic and economic inequalities in access to maternal health services between 2006 to 2011-12 and 2011-12 to 2017. METHODS We used the three most recent Lao Social Indicator Survey datasets conducted in 2006, 2011-12, and 2017 for this analysis. We assessed wealth, area of residence, ethnicity, educational attainment, and women's age-related inequalities in the use of at least one antenatal care (ANC) visit with skilled personnel, institutional delivery, and at least one facility-based postnatal care (PNC) visit by mothers. The magnitude of inequalities was measured using concentration curves, concentration indices (CIX), and equiplots. RESULTS The coverage of at least one ANC with skilled personnel increased the most between 2012 and 2017, by 37.1% in Hmong minority ethnic group women, 36.1% in women living in rural areas, 31.1%, and 28.4 in the poorest and poor, respectively. In the same period, institutional deliveries increased the most among women in the middle quintiles by 32.8%, the poor by 29.3%, and Hmong women by 30.2%. The most significant reduction in inequalities was related to area of residence between 2006 and 2012 while it was based on wealth quintiles in the period 2011-12 to 2017. Finally, in 2017, wealth-related inequalities in institutional delivery remained high, with a CIX of 0.193 which was the highest of all CIX values. CONCLUSION There was a significant decline in inequalities based on the area of residence in the use of maternal health services between 2006 and 2011-12 while between 2011-12 and 2017, the largest decrease was based on wealth quintiles. Policies and strategies implemented since 2011-12 might have been successful in improving access to maternal health services in Lao PDR. Meanwhile, more attention should be given to improving the uptake of facility-based PNC visits.
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Affiliation(s)
| | - Daisuke Nonaka
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Nishihara, Japan
| | - Rie Takeuchi
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Nishihara, Japan
| | - Calvin de Los Reyes
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Nishihara, Japan
- College of Arts and Sciences, University of the Philippines Manila, Manila, Philippines
| | - Manami Uehara
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Nishihara, Japan
| | - Phongluxa Khampheng
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao PDR
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao PDR
| | - Jun Kobayashi
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Nishihara, Japan
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10
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Aiello I, Kounnavong S, Vinathan H, Philavong K, Luangphaxay C, Soukhavong S, Blomberg J, Wieringa FT. Short-Term Acceptability of Ready-to-Use Therapeutic Foods in Two Provinces of Lao People's Democratic Republic. Nutrients 2023; 15:3847. [PMID: 37686879 PMCID: PMC10489829 DOI: 10.3390/nu15173847] [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: 08/01/2023] [Revised: 08/23/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND In Lao PDR, acute malnutrition remains a public health problem, with around 9% of children under 5 being affected. Outpatient treatment of severe acute malnutrition requires ready-to-use therapeutic foods (RUTFs), but concerns have been raised about the acceptability of globally available products. Culturally acceptable RUTFs could be locally developed, but data are lacking on RUTF preferences in Lao PDR. METHODS In a crossover-designed study, four different RUTFs were tested for short-term acceptability and organoleptic qualities (two globally available: peanut-based, which is the current standard, and wheat-milk-based RUTFs; two regionally produced: a mung-bean-based and a fish-rice-based RUTF). Organoleptic properties were evaluated by 83 caretaker-child pair participants through a taste test and a 30 min consumption test. Short-term acceptability was assessed through a 3-day intake test. The study sites were in Phongsaly (North Laos) and Attapeu (South Laos). Focus group discussions were conducted at the beginning and the end of the study. RESULTS The mung bean RUTF was the favorite among caretakers, with an acceptability percentage of 96.2%, and scored better (p-value < 0.05) for all organoleptic variables than the other three RUTFs. Overall, 3 days after receiving take-home rations, the mean percentage of consumption was above 80% for all the RUTFs, with the mung bean product being the most consumed. CONCLUSIONS The regionally produced mung bean RUTF was the most accepted, whereas the other regionally produced fish-based RUTF was the least accepted, showing the complexity of finding culturally acceptable solutions to fight malnutrition. For Lao PDR, a mung-bean-based RUTF seems the way forward, even if the current standard peanut-based RUTF appeared to be acceptable, albeit not the most preferred.
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Affiliation(s)
- Iacopo Aiello
- Faculty of Medicine, Aix-Marseille University, AP-HM, 13385 Marseille, France;
- Food, Nutrition, Health, UMR QualiSud, French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
- Health and Nutrition Section, UNICEF, Vientiane, Laos; (H.V.); (J.B.)
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ban Kaognot, Sisattanack District, Vientiane, Laos; (S.K.); (C.L.)
| | - Hari Vinathan
- Health and Nutrition Section, UNICEF, Vientiane, Laos; (H.V.); (J.B.)
| | - Khamseng Philavong
- Centre of Nutrition (CoN), Ministry of Health (MoH), Ban Xiengda, Vientiane, Laos;
| | - Chanthaly Luangphaxay
- Lao Tropical and Public Health Institute, Ban Kaognot, Sisattanack District, Vientiane, Laos; (S.K.); (C.L.)
| | | | - Janneke Blomberg
- Health and Nutrition Section, UNICEF, Vientiane, Laos; (H.V.); (J.B.)
| | - Frank T. Wieringa
- Food, Nutrition, Health, UMR QualiSud, French National Research Institute for Sustainable Development (IRD), 34394 Montpellier, France
- UMR QualiSud, CIRAD, University of Montpellier, SupAgro, IRD, University of Avignon, University of Reunion, 34394 Montpellier, France
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11
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Thilakoun K, Reinharz D, Kounnavong S. The Concepts of Women's Empowerment in Child Malnutrition Programs in Luangprabang Province, Lao People's Democratic Republic. Int J Environ Res Public Health 2023; 20:6662. [PMID: 37681802 PMCID: PMC10487523 DOI: 10.3390/ijerph20176662] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/26/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
In several developing countries, such as Lao People's Democratic Republic (Lao PDR), the fight against malnutrition is carried out through programs that involve collaboration between internal (national) and external (international) actors. These actors may have different perceptions on what is one of the pillars of these programs: the empowerment of women, especially mothers of young children. Little is known about these differences and the impact of these differences on the empowerment component of collaborative projects and the perception of its impact on the reduction in malnutrition in the country. A multiple case study was performed. Data collection was carried out in Vientiane Capital and Luangprabang province. The data were obtained from (1) documents, (2) semi-structured interviews with representatives of internal and external organizations, and (3) focus group discussions and individual interviews with mothers of children under five years old. Analysis consisted of characterizing the empowerment component of nutrition programs of internal and external organizations, as well as mothers, based on an OXFAM's adapted conceptual framework on women's economic empowerment. The study revealed a common understanding among government and external organizations regarding the significance of promoting women's empowerment for reducing child malnutrition in Lao PDR. However, variations were observed in the interpretation of specific determinants of women's empowerment, specifically in relation to women's autonomy and the role of social capital. The perspective of internal actors includes the political ideology and traditions that make Lao PDR a distinct country. This perspective dominates the nutrition programs conducted under the collaboration of internal and external actors. In Lao PDR, the concept of women's empowerment in nutrition programs conducted through collaboration between internal and external actors and targeting young Lao mothers gives prominence to political and socio-cultural factors.
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Affiliation(s)
- Kanchana Thilakoun
- Department of Social and Preventive Medicine, Laval University, Laval, QC G1V 0A6, Canada;
| | - Daniel Reinharz
- Department of Social and Preventive Medicine, Laval University, Laval, QC G1V 0A6, Canada;
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12
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Huang S, Toole M, Renzaho AM, Kounnavong S, Watts JJ, Coghlan B. Protocol for integrated solutions for healthy birth, growth and development: a cluster-randomised controlled trial to evaluate the effectiveness of a mixed nutrition intervention package in reducing child undernutrition in Lao People's Democratic Republic. BMJ Open 2023; 13:e066014. [PMID: 37586866 PMCID: PMC10432663 DOI: 10.1136/bmjopen-2022-066014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/19/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION While Lao People's Democratic Republic has seen economic gains in recent years, one-third of children aged 5 years and under are stunted. There is a need for evidence around clinically effective and cost-effective integrated nutrition-specific and nutrition-sensitive interventions in the local context. METHODS AND ANALYSIS We aim to conduct a cluster-randomised control trial to test the effectiveness of an integrated package of community-based nutrition-specific and nutrition-sensitive interventions compared with the standard government package of nutrition actions. The trial will be in six districts within the province of Vientiane. We will recruit pregnant women in their third trimester and follow the children born to them every 6 months until 18 months of age. A total of 256 villages (serviced by 34 health centres) will be randomised to a control arm or an intervention arm using a minimisation algorithm. The primary outcome is the prevalence of stunting among children aged 6, 12 and 18 months. The secondary outcomes include prevalence of low birth weight and wasting among children aged 6, 12 and 18 months. Analyses for the primary and secondary outcomes will be conducted at the mother-infant dyad level and adjusted for the cluster randomisation. The difference in prevalence of low birth weight, wasting and stunting between control and intervention groups will be assessed using Pearson's χ2 tests and 95% CIs for the group difference, adjusted for clustering. ETHICS AND DISSEMINATION The trial protocol was approved by the Alfred Human Research Ethic Committee (Ref: 227/16) and the Lao National Ethics Committee for Health Research (Ref: 81). The trial was registered with the Australian New Zealand Clinical Trials Registry on 28 April 2020 (ACTRN12620000520932). The results will be disseminated at different levels: study participants; the local community; other Lao stakeholders including policymakers; and an international audience. TRIAL REGISTRATION NUMBER Australia New Zealand Clinical Trials Registry: ACTRN12620000520932.
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Affiliation(s)
- Shan Huang
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Michael Toole
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Andre Mn Renzaho
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic
| | - Jennifer J Watts
- Faculty of Health, School of Health & Social Development, Deakin University, Burwood, Victoria, Australia
| | - Ben Coghlan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
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13
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Sengchaleun V, Kounnavong S, Reinharz D. Emergence of National Nutrition Policy in the Lao People's Democratic Republic: an analysis of collaborations between governmental and external actors. Trop Med Health 2023; 51:43. [PMID: 37553606 PMCID: PMC10408052 DOI: 10.1186/s41182-023-00532-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/25/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND In most developing countries, addressing malnutrition involves a coalition of stakeholders that includes the government and international development partners. This study explores the evolution of the malnutrition actor coalition landscape before and after the emergence of the National Nutrition Policy in the Lao People's Democratic Republic (Lao PDR) in 2008. METHODS A qualitative study was conducted based on the theory of coalition structuring. Twenty semi-structured interviews were performed with representatives of national and international organisations involved in addressing malnutrition in Lao PDR. The information obtained from the interviews was complemented by an analysis of relevant documents dating back to 1990. Interviews were recorded and transcribed verbatim. A thematic analysis was performed using NVivo 11 software and the diagrams of collaboration drawn by the participants were turned into a visual collaboration map using SocNetV software. We relied on various types of triangulation to increase the analysis's credibility, reliability, and confirmability. RESULTS The results showed that before the emergence of the National Nutrition Policy, three coalitions representing the health, agriculture, and education sectors coexisted. These colalitions worked largely in silos, although with some interactions when deemed necessary mainly by United Nations agencies. The emergence of the National Nutrition Policy provided the government with an effective political tool for coalescing the three coalitions into a unique coalition involving all major stakeholders in the nutrition field. All three forces that incite actors to collaborate inside a coalition according to the theory of coalition structuring (transactions, control, intangible factors) were mobilised in the creation of the single coalition. CONCLUSIONS Combating malnutrition is a government priority in the Lao PDR. The current study showed that the National Nutrition Policy in Lao PDR has led to a significant evolution in the malnutrition coalition landscape, resulting in improved collaboration among stakeholders. This finding highlights the effectiveness of public policies in facilitating intersectoral activities to tackle complex problems, such as malnutrition.
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Affiliation(s)
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao PDR
| | - Daniel Reinharz
- Department of Social and Preventive Medicine, Laval University, Quebec, QC, Canada
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14
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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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15
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Barffour MA, Bernstein RM, Hinnouho GM, Wessells KR, Arnold CD, Kounnavong S, Hess SY. Insulin-like Growth Factor 1 (IGF1), IGF Binding Protein-3 (IGFBP3) and Growth Response to Daily Zinc Supplementation: A Randomized Trial in Rural Laotian Children. Nutrients 2023; 15:nu15112590. [PMID: 37299552 DOI: 10.3390/nu15112590] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/22/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVES To assess (a) the impact of daily preventive zinc tablets (7 mg; PZ), zinc-containing multiple micronutrient powder (10 mg zinc, and 13 other micronutrients; MNP) or placebo, delivered for 9 months, on Insulin-like Growth Factor 1 (IGF1) and IGF Binding Protein 3 (IGFBP3) among Laotian children 6-23 months, and (b) whether the effects of PZ and MNP on length-for-age z-scores (LAZ) and weight-for-age z-scores (WAZ) are modified by baseline IGF1 and IGFBP3. DESIGN A double-blind, placebo-controlled trial (N = 419). METHODS Plasma IGF1 and IGFBP3 concentrations at baseline and 36 weeks were analyzed by automated chemiluminescent assay. Anthropometry was assessed at baseline, at 18 and 36 weeks. Intervention effects were estimated using ANCOVA. RESULTS At 36 weeks, geometric mean IGF1 (~39.0-39.2 ng/mL; p = 0.99) and IGFBP3 (2038-2076 ng/mL; p = 0.83) did not differ by group. At 18 weeks (but not at 36 weeks), LAZ in the PZ group (-1.45) was higher than the MNP (-1.70) and control (-1.55) groups (p = 0.01) among children in the highest baseline IGF1 tertile (p for interaction = 0.006). At 36 weeks (but not at 18 weeks), WAZ in the PZ group (-1.55) was significantly higher than the MNP (-1.75) and control (-1.65) groups (p = 0.03), among children in the lowest baseline IGFBP3 tertile (p for interactions = 0.06). CONCLUSIONS Although IGF1 and IGFBP3 did not respond to PZ and MNP, baseline IGF1 and IGFBP3 significantly modified the impact of PZ on linear and ponderal growth, suggesting that IGF1 bioavailability may drive catch-up growth in zinc-supplemented children.
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Affiliation(s)
- Maxwell A Barffour
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, CA 95616, USA
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA
- Public Health Program, McQueary College of Health and Human Services, Missouri State University, Springfield, MO 65897, USA
| | - Robin M Bernstein
- Department of Anthropology, University of Colorado, Boulder, CO 80309, USA
- Health and Society Program, Institute for Behavioral Science, University of Colorado, Boulder, CO 80309, USA
| | - Guy-Marino Hinnouho
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, CA 95616, USA
- Helen Keller International, Washington, DC 20006, USA
| | - K Ryan Wessells
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, CA 95616, USA
| | - Charles D Arnold
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, CA 95616, USA
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ban Kaognot, Sisattanack District, Vientiane 01030, Laos
| | - Sonja Y Hess
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, CA 95616, USA
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16
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Tamarelle J, Creze MM, Savathdy V, Phonekeo S, Wallenborn J, Siengsounthone L, Fink G, Odermatt P, Kounnavong S, Sayasone S, Vonaesch P. Dynamics and consequences of nutrition-related microbial dysbiosis in early life: study protocol of the VITERBI GUT project. Front Nutr 2023; 10:1111478. [PMID: 37275646 PMCID: PMC10232750 DOI: 10.3389/fnut.2023.1111478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/29/2022] [Accepted: 05/02/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction Early life under- and overnutrition (jointly termed malnutrition) is increasingly recognized as an important risk factor for adult obesity and metabolic syndrome, a diet-related cluster of conditions including high blood sugar, fat and cholesterol. Nevertheless, the exact factors linking early life malnutrition with metabolic syndrome remain poorly characterized. We hypothesize that the microbiota plays a crucial role in this trajectory and that the pathophysiological mechanisms underlying under- and overnutrition are, to some extent, shared. We further hypothesize that a "dysbiotic seed microbiota" is transmitted to children during the birth process, altering the children's microbiota composition and metabolic health. The overall objective of this project is to understand the precise causes and biological mechanisms linking prenatal or early life under- or overnutrition with the predisposition to develop overnutrition and/or metabolic disease in later life, as well as to investigate the possibility of a dysbiotic seed microbiota inheritance in the context of maternal malnutrition. Methods/design VITERBI GUT is a prospective birth cohort allowing to study the link between early life malnutrition, the microbiota and metabolic health. VITERBI GUT will include 100 undernourished, 100 normally nourished and 100 overnourished pregnant women living in Vientiane, Lao People's Democratic Republic (PDR). Women will be recruited during their third trimester of pregnancy and followed with their child until its second birthday. Anthropometric, clinical, metabolic and nutritional data are collected from both the mother and the child. The microbiota composition of maternal and child's fecal and oral samples as well as maternal vaginal and breast milk samples will be determined using amplicon and shotgun metagenomic sequencing. Epigenetic modifications and lipid profiles will be assessed in the child's blood at 2 years of age. We will investigate for possible associations between metabolic health, epigenetics, and microbial changes. Discussion We expect the VITERBI GUT project to contribute to the emerging literature linking the early life microbiota, epigenetic changes and growth/metabolic health. We also expect this project to give new (molecular) insights into the mechanisms linking malnutrition-induced early life dysbiosis and metabolic health in later life, opening new avenues for microbiota-engineering using microbiota-targeted interventions.
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Affiliation(s)
- Jeanne Tamarelle
- Department of Fundamental Microbiology, University of Lausanne, Lausanne, Switzerland
| | - Margaux M. Creze
- Department of Fundamental Microbiology, University of Lausanne, Lausanne, Switzerland
| | - Vanthanom Savathdy
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People’s Democratic Republic (PDR)
| | - Sengrloun Phonekeo
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People’s Democratic Republic (PDR)
| | - Jordyn Wallenborn
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Latsamy Siengsounthone
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People’s Democratic Republic (PDR)
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Peter Odermatt
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People’s Democratic Republic (PDR)
| | - Somphou Sayasone
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People’s Democratic Republic (PDR)
| | - Pascale Vonaesch
- Department of Fundamental Microbiology, University of Lausanne, Lausanne, Switzerland
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17
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Mizuno Y, Inaba Y, Masuoka H, Kibe M, Kosaka S, Natsuhara K, Hirayama K, Inthavong N, Kounnavong S, Tomita S, Umezaki M. Determinants of oxidative stress among indigenous populations in Northern Laos: Trace element exposures and dietary patterns. Sci Total Environ 2023; 868:161516. [PMID: 36646220 DOI: 10.1016/j.scitotenv.2023.161516] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To investigate determinants of oxidative stress in an indigenous population, we examined associations of trace element exposures and dietary patterns with three oxidative stress-related biomarkers among indigenous populations in Northern Laos. METHODS This cross-sectional study included 341 adults from three villages with different levels of modernization. We used three oxidative stress-related biomarkers: urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) and 8-isoprostane concentrations, which were measured using liquid chromatography-tandem mass spectrometry, and blood telomere lengths, which were measured using a quantitative polymerase chain reaction method. We used multilevel analysis to examine associations of urinary arsenic, cadmium, and selenium concentrations, their interaction terms, and wild-plant-food scores (principal component scores calculated from food consumption frequencies) with oxidative stress-related biomarkers. RESULTS Urinary arsenic and cadmium concentrations were positively associated with urinary 8-isoprostane concentrations. Urinary selenium concentrations were positively associated with urinary 8-OHdG concentrations. Interaction terms ([arsenic or cadmium] × selenium) showed negative associations with urinary 8-OHdG and 8-isoprostane concentrations, respectively. Urinary cadmium concentrations were negatively associated with telomere lengths. Wild-plant-food scores did not exhibit associations with oxidative stress-related biomarkers. CONCLUSION Our findings imply that exposure to arsenic and cadmium is associated with greater oxidative lipid damage, whereas selenium may attenuate arsenic-induced oxidative DNA damage and cadmium-induced oxidative lipid damage. Cadmium exposure may accelerate telomere attrition. Trace element exposure may be a determinant of oxidative stress among indigenous populations in Northern Laos.
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Affiliation(s)
- Yuki Mizuno
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Yohei Inaba
- Department of Environmental Health, National Institute of Public Health, Saitama, Japan.
| | - Hiroaki Masuoka
- RIKEN Center for Integrative Medical Sciences, Yokohama, Japan.
| | - Mihoko Kibe
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Satoko Kosaka
- Department of Public Health & Nursing, Nagasaki University, Nagasaki, Japan.
| | | | - Kazuhiro Hirayama
- Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan.
| | - Nouhak Inthavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao Democratic People's Republic
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao Democratic People's Republic
| | - Shinsuke Tomita
- Graduate School of Environmental Studies, Nagoya University, Nagoya, Japan.
| | - Masahiro Umezaki
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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Mizuno Y, Inaba Y, Masuoka H, Kibe M, Kosaka S, Natsuhara K, Hirayama K, Inthavong N, Kounnavong S, Tomita S, Umezaki M. Impact of modernization on oxidative stress among indigenous populations in northern Laos. Am J Biol Anthropol 2023. [PMID: 36919625 DOI: 10.1002/ajpa.24722] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/30/2022] [Accepted: 02/12/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To explore the impact of modernization on oxidative stress during a momentous health transition process, we investigated differences in oxidative stress among the indigenous populations of villages in northern Laos with different levels of modernization. METHODS We conducted a cross-sectional study of 380 adults in three villages with different levels of modernization. Three biomarkers related to oxidative stress were measured: urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) and 8-isoprostane concentrations (both measured by liquid chromatography-tandem mass spectrometry), and blood telomere length (measured with qPCR). We examined associations between village-level modernization and oxidative stress-related biomarkers in a multilevel analysis including a random effect and covariates. RESULTS The geometric means of urinary 8-OHdG and 8-isoprostane concentrations were 2.92 and 0.700 μg/g creatinine, respectively, in our study population. Higher urinary 8-OHdG concentrations and shorter telomeres were observed in participants from the more modernized villages, whereas urinary 8-isoprostane concentrations did not differ significantly among villages. CONCLUSIONS Our findings imply that modernization-induced changes in lifestyle may increase oxidative DNA damage. Baseline levels of oxidative lipid damage are expected to be high in the indigenous populations of northern Laos. Assessments of oxidative stress may provide valuable insights into the mechanisms of health transition in specific populations.
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Affiliation(s)
- Yuki Mizuno
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yohei Inaba
- Department of Environmental Health, National Institute of Public Health, Saitama, Japan
| | - Hiroaki Masuoka
- RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Mihoko Kibe
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoko Kosaka
- Department of Public Health and Nursing, Nagasaki University, Nagasaki, Japan
| | | | - Kazuhiro Hirayama
- Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Nouhak Inthavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Laos
| | | | - Shinsuke Tomita
- Graduate School of Environmental Studies, Nagoya University, Nagoya, Japan
| | - Masahiro Umezaki
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Ito T, Kounnavong S, Miyoshi C. Correction: Financial burden and health-seeking behaviors related to chronic diseases under the National Health Insurance Scheme in Bolikhamxay Province, Lao PDR: a cross-sectional study. Int J Equity Health 2023; 22:35. [PMID: 36823627 PMCID: PMC9951404 DOI: 10.1186/s12939-023-01827-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Affiliation(s)
- Tomoo Ito
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Sengchanh Kounnavong
- grid.415768.90000 0004 8340 2282Lao Tropical and Public Health Institute, Ministry of Health, Samsenethai Road, Ban Kaognot, Sisattanack District, Vientiane Capital Lao PDR
| | - Chiaki Miyoshi
- grid.45203.300000 0004 0489 0290Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655 Japan
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20
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Arong A, Srivorakun H, Chaibunruang A, Fucharoen S, Fucharoen G, Kounnavong S, Sanchaisuriya K. Hemoglobin EE disease in young Laotian children: Hematologic features and the contributions of genetic variations to Hb F expression. Int J Lab Hematol 2023; 45:387-393. [PMID: 36597281 DOI: 10.1111/ijlh.14017] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The wide variation in hemoglobin (Hb) F levels has been observed in patients with Hb EE disease. This study aimed to describe hematologic features and determine the effect of genetic variants on Hb F expression in young children with Hb EE disease. METHODS Hematologic features and Hb profiles of Laotian children aged 6-23 months, who originally enrolled in the Lao-Zinc study, were retrospectively reviewed. Only children with Hb EE disease, as indicated by DNA analysis, were included in this current analysis. Genetic variants, including the G γ-XmnI polymorphism (C>T) of the HBG2 gene, the HBS1L-MYB intergenic region on chromosome 6, and the BCL11A on chromosome 2 as well as the mutations occurring on the Krüppel-like factor 1 (KLF1) gene, were examined. RESULTS In total, 205 children were diagnosed as having Hb EE disease with Hb F ranged from 1.2 to 43.7%. Most of the children had mild to moderate anemia with a remarkable microcytosis. Analysis of the genetic variants revealed an extremely high frequency of the G γ-XmnI (93.7%). Applying multiple regression analysis adjusted for age, sex, and α-thal gene, a positive relation was observed for the rs4671393 (coefficient = 3.87, p = .005) and the rs2297339 (coefficient = 2.48, p = .046), but not the G γ-XmnI. A statistically non-significant relation was noted for the rs9399137 and the -154 (C>T) KLF1 mutation. CONCLUSION Our findings provide insight into complex situation of Hb F variability in young children with Hb EE disease; and this can guide to appropriate care and counseling to affected families.
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Affiliation(s)
- Areeda Arong
- Graduate School, Khon Kaen University, Khon Kaen, Thailand
| | - Hathichanok Srivorakun
- Centre for Research and Development of Medical Diagnostic Laboratories (CMDL), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Attawut Chaibunruang
- Centre for Research and Development of Medical Diagnostic Laboratories (CMDL), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Supan Fucharoen
- Centre for Research and Development of Medical Diagnostic Laboratories (CMDL), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Goonnapa Fucharoen
- Centre for Research and Development of Medical Diagnostic Laboratories (CMDL), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Kanokwan Sanchaisuriya
- Centre for Research and Development of Medical Diagnostic Laboratories (CMDL), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
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21
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Ito T, Kounnavong S, Miyoshi C. Financial burden and health-seeking behaviors related to chronic diseases under the National Health Insurance Scheme in Bolikhamxay Province, Lao PDR: a cross-sectional study. Int J Equity Health 2022; 21:180. [PMID: 36527068 PMCID: PMC9758772 DOI: 10.1186/s12939-022-01788-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/25/2021] [Accepted: 11/10/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Chronic diseases pose a serious threat to health and longevity worldwide. As chronic diseases require long periods of treatment and may become serious conditions, the ensuing financial burden is often worse than that for non-chronic diseases. In 2016, the Lao PDR implemented the National Health Insurance (NHI) system, which covers select provinces. However, data on health service accessibility and the financial burden on households, especially those with chronically ill members covered by the NHI, are scarce. METHODS This study used a cross-sectional design. Data collection was conducted in Bolikhamxay province (population = 273,691), from January 15 to February 13, 2019. In total, 487 households, selected through stratified random sampling, were surveyed via questionnaire-based interviews. Healthcare service usage and financial burden were examined. RESULTS A total of 370 households had at least one member with self-reported health issues within the last 3 months prior to the interview, while 170 had at least one member with a chronic condition. More than 75% of the households accessed a health facility when a member experienced health problems. The majority of households (43.2%) spent the maximum value covered by the NHI, but households in the second largest group (21.4%) spent 10 times the maximum value covered by the NHI. The prevalence of catastrophic health expenditure (i.e., health-related expenditure equivalent to > 20% of total income) was 25.9% (20% threshold) and 16.2% (40% threshold). Through logistic regression, we found that the major factors determining financial catastrophes owing to health problems were household members with chronic illness, hospitalization, household poverty status, household size (for both the 20 and 40% thresholds), visiting a private facility (20% threshold), and distance from the province to the referral hospital (40% threshold). CONCLUSIONS The NHI system has had a positive effect on households' access to health facilities. However, catastrophic health expenditure remains high, especially among chronically ill patients. Facilities under the NHI system should be improved to provide more services, including care for chronic conditions.
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Affiliation(s)
- Tomoo Ito
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Sengchanh Kounnavong
- grid.415768.90000 0004 8340 2282Lao Tropical and Public Health Institute, Ministry of Health, Samsenethai Road, Ban Kaognot, Sisattanack District, Vientiane Capital, Lao PDR
| | - Chiaki Miyoshi
- grid.45203.300000 0004 0489 0290Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655 Japan
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22
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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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23
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Nonaka D, Inthavong N, Takahashi K, Chanthakoumane K, Toyama Y, Luangphaxay C, Pongvongsa T, Kounnavong S. Primary health care situations in remote rural villages of the Savannakhet province, Lao People's Democratic Republic. Trop Med Health 2022; 50:90. [PMID: 36443857 PMCID: PMC9703750 DOI: 10.1186/s41182-022-00482-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/19/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To improve the health of the rural population in the Lao People's Democratic Republic (Lao PDR), the government has emphasized a primary health care approach in the Health Sector Reform Strategy by 2025. The objective of the present study was to describe the health-related situations of remote rural villages of the Lao PDR to inform strategies for promoting primary health care in such villages. METHODS Ten remote rural villages were purposively selected from the catchment areas of two health centers in the Xepon district, Savannakhet province. The surveyors collected data by conducting a questionnaire-based interview with village health volunteers and by observing the village environment in 2018. The survey focused on village situations on the eight elements of primary health care (health education; food supply and nutrition; safe water and basic sanitation; maternal and child health care; immunization; prevention and control of locally endemic diseases; treatment of common diseases and injuries; and provision of essential drug). RESULTS The common health problems were diarrhea, followed by malaria, and cough. The identified possible risk factors for the health problems were not washing hands with soap, open defecation, not boiling drinking water, not exclusively breastfeeding, presence of animal feces on the village ground, absence of garbage management system, not using a bed net when sleeping in the forest, and exposure to indoor cooking and tobacco smoke. In many villages, villagers were not able to eat enough food and did not eat protein-rich food and vegetables daily. CONCLUSIONS Potential risk factors for the reported common health problems were often prevalent in the study villages. Villagers can address most of these risk factors, as interventions to address such risk factors do not require a large financial input. There is a need for intersectoral actions between the health and other sectors to address food shortages and indoor air pollution due to indoor cooking using biomass fuel.
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Affiliation(s)
- Daisuke Nonaka
- grid.267625.20000 0001 0685 5104Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Nouhak Inthavong
- grid.415768.90000 0004 8340 2282Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People’s Democratic Republic
| | - Kenzo Takahashi
- grid.264706.10000 0000 9239 9995Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Ketmany Chanthakoumane
- grid.415768.90000 0004 8340 2282Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People’s Democratic Republic
| | - Yuko Toyama
- grid.267625.20000 0001 0685 5104Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Chanthaly Luangphaxay
- grid.415768.90000 0004 8340 2282Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People’s Democratic Republic
| | - Tiengkham Pongvongsa
- grid.415768.90000 0004 8340 2282Savannakhet Provincial Health Department, Ministry of Health, Savannakhet, Lao People’s Democratic Republic
| | - Sengchanh Kounnavong
- grid.415768.90000 0004 8340 2282Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People’s Democratic Republic
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Kewcharoenwong C, Sein MM, Nithichanon A, Khongmee A, Wessells KR, Hinnouho GM, Barffour MA, Kounnavong S, Hess SY, Stephensen CB, Lertmemongkolchai G. Daily preventive zinc supplementation increases the antibody response against pathogenic Escherichia coli in children with zinc insufficiency: a randomised controlled trial. Sci Rep 2022; 12:16084. [PMID: 36167891 PMCID: PMC9515173 DOI: 10.1038/s41598-022-20445-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/13/2022] [Indexed: 12/03/2022] Open
Abstract
Zinc deficiency impairs the antibody-mediated immune response and is common in children from lower-income countries. This study aimed to investigate the impact of different zinc supplementation regimens (7, 10 or 20 mg/day elemental zinc)—therapeutic dispersible zinc tablets (TZ), daily multiple micronutrient powder (MNP), daily preventive zinc tablets (PZ) and placebo powder (control)—and compare between baseline and endline antibody production against pathogenic Escherichia coli in Laotian children (aged 6–23 months). Fifty representative plasma samples of each treatment group were randomly selected from 512 children to determine anti-E. coli IgG antibody levels and avidity. Of the 200 children, 78.5% had zinc deficiency (plasma zinc concentration < 65 µg/dL) and 40% had anaemia before receiving zinc supplementation. aAfter receiving the TZ, MNP or PZ regimen, the plasma anti-E. coli IgG levels were significantly increased compared with baseline; the effect on the antibody level was more pronounced in children with zinc deficiency. Interestingly, there was increased anti-E. coli IgG avidity in the control and PZ groups. This study suggests that PZ might be the optimal zinc supplementation regimen to increase both the quantity and quality of antibody responses in children with zinc deficiency. Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT02428647 (NCT02428647, 29/04/2015).
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Affiliation(s)
| | - Myint Myint Sein
- The Centre for Research & Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Arnone Nithichanon
- Department of Microbiology, Faculty of Medicine, Research and Diagnostic Center for Emerging Infectious Diseases (RCEID), Khon Kaen University, Khon Kaen, Thailand
| | - Aranya Khongmee
- The Centre for Research & Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - K Ryan Wessells
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA, USA
| | - Guy-Marino Hinnouho
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA, USA.,Helen Keller International, Washington, DC, USA
| | - Maxwell A Barffour
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA, USA.,Public Health Program, College of Health and Human Services, Missouri State University, Springfield, MO, USA
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic
| | - Sonja Y Hess
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA, USA
| | - Charles B Stephensen
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA, USA.,Agricultural Research Service, Western Human Nutrition Research Center, USDA, Davis, CA, USA
| | - Ganjana Lertmemongkolchai
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand. .,The Centre for Research & Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.
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25
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Kounnavong S, Yan W, Sihavong A, Sychareun V, Eriksen J, Hanson C, Chaleunvong K, Keohavong B, Vongsouvath M, Mayxay M, Brauner A, Stålsby Lundborg C, Machowska A. Antibiotic knowledge, attitudes and reported practice during pregnancy and six months after birth: a follow- up study in Lao PDR. BMC Pregnancy Childbirth 2022; 22:701. [PMID: 36096811 PMCID: PMC9465860 DOI: 10.1186/s12884-022-05018-x] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/26/2022] [Indexed: 12/03/2022] Open
Abstract
Background Antibiotics are important medicines to prevent maternal and child morbidity and mortality. Women’s knowledge and attitudes towards antibiotic use influence their practice. When they become mothers, this may be mirrored in the use of antibiotics for their newborn children. The current study aimed to assess knowledge, attitudes, and reported practice of pregnant women regarding antibiotic use and antibiotic resistance as well as their approach towards antibiotic use for their newborn babies. Methods This was a follow-up study with data collected via structured interviews between September 2019 and August 2020 in Feuang (rural) and Vangvieng (urban) districts in Vientiane province, Lao PDR. We identified and invited all women attending antenatal care in their third trimester of pregnancy in the selected areas. Using a structured questionnaire at third trimester of pregnancy we captured data on knowledge regarding antibiotic use and resistance. We collected information on attitudes and reported practice at two time points: (i) at third trimester of pregnancy and (ii) 6 months after birth. Univariate analysis and frequency distributions were used to study pattern of responses. Chi-square and Mann-Whitney tests were used to compare categorical and continuous variables respectively. P value < 0.05 was considered statistically significant. Results We surveyed 539 women with a mean age of 25 years. Two oral antibiotics, i) ampicillin and ii) amoxicillin were correctly identified by 68 and 47% of participants respectively. Only 24% of women (19% in Feuang and 29% in Vangvieng) answered correctly that antibiotics are effective against bacterial infections. The most prevalent response was “I don’t know” suggesting the questions were challenging. Significantly less women would use antibiotics from a previous illness for their child than for themselves (16% vs 29%), however they would be more willing to use antibiotics for their baby even in case of mild symptoms (29% vs 17% while pregnant). The majority of antibiotics were prescribed by healthcare providers and 46% of children with the common cold received antibiotics. Conclusions Women’s knowledge was sub-optimal, still, they manifested appropriate attitudes towards antibiotic use during pregnancy and for their child. Nearly half of children received antibiotics for the common cold. There is a need for context adapted programs aiming at improving women’s knowledge, as well as healthcare providers, emphasising rational antibiotic prescribing during pregnancy and for children.
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Affiliation(s)
- Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao PDR
| | - Weirong Yan
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Amphoy Sihavong
- Vientiane Capital Health Department, Ministry of Health, Vientiane, Lao PDR
| | | | - Jaran Eriksen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases/Venhalsan, Stockholm South General Hospital, Stockholm, Sweden
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Kongmany Chaleunvong
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao PDR
| | | | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Welcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Welcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.,Institute of Research and Education Development, UHS, Ministry of Health, Vientiane, Lao PDR.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Annelie Brauner
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Division of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Anna Machowska
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
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26
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Sychareun V, Phounsavath P, Sihavong A, Kounnavong S, Chaleunvong K, Machowska A, Keohavong B, Mayxay M, Eriksen J, Hanson C, Vongsouvath M, Brauner A, Durham J, Stålsby Lundborg C. Perceptions and reported practices of pregnant women and mothers of children under two years of age regarding antibiotic use and resistance in Vientiane province, Lao PDR: a qualitative study. BMC Pregnancy Childbirth 2022; 22:569. [PMID: 35842597 PMCID: PMC9287906 DOI: 10.1186/s12884-022-04894-7] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding pregnant women and mothers' perceptions towards antibiotic use and resistance is essential for appropriate antibiotic use and limiting antibiotic resistance. This study aimed to explore perceptions and reported practices of pregnant women and mothers with children under two years of age regarding correct antibiotic use and antibiotic resistance in Vientiane Province, Lao PDR. METHODS The study employed an exploratory qualitative research design using focus groups discussions (FGDs). Participants were purposively selected based on: being pregnant at third trimester and attending antenatal care and mothers with children under two years of age, attending the health facility for postpartum visit /vaccinations. Six focus group discussions were conducted in September 2019 with a total of 55 women. The FGDs were transcribed verbatim, data were analyzed first by coding then categorizing the data as we looked for patterns and themes by using the qualitative content analysis. RESULTS Most participants had some understanding of antibiotics but wrongly believed antibiotics can be used to treat viral disease. Over half of the participants had heard the term "antibiotic resistance", but often believed it was their bodies, not the bacteria that developed antibiotic resistance. During pregnancy and for their infants, women preferred to use antibiotics only when prescribed by a doctor. Outside of pregnancy however, consuming antibiotics without a prescription was commonly reported. Participants wanted more information about the indications for antibiotic use and antibiotic resistance. CONCLUSIONS More effort is required to increase the level of understanding, and practice of mothers to promote optimal antibiotic use. Mothers' desire to learn more, and their fundamental concern for their children, can be used to promote appropriate antibiotic use. Awareness raising should be complemented by efforts to address other determinants of inappropriate antibiotic use, including educating healthcare workers, and pharmacists and addressing health service determinants that contribute to inappropriate antibiotic use.
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Affiliation(s)
- Vanphanom Sychareun
- Faculty of Public Health, University of Health Sciences (UHS), Vientiane, Lao PDR
| | | | - Amphoy Sihavong
- Vientiane Capital Health Department, MOH, Vientiane, Lao PDR
| | - Sengchanh Kounnavong
- Lao Tropical & Public Health Institute, Ministry of Health (MOH), Vientiane, Lao PDR
| | | | - Anna Machowska
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Mayfong Mayxay
- Institute of Research and Education Development, UHS, MOH, Vientiane, Lao PDR.,Lao-Oxford-Mahosot Hospital-Welcome Trust Research Unit (LOMWRU), Microbiology. Laboratory, Mahosot Hospital, MOH, Vientiane, Lao PDR.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jaran Eriksen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden. .,Department of infectious diseases, Stockholm South General Hospital, Stockholm, Sweden.
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Welcome Trust Research Unit (LOMWRU), Microbiology. Laboratory, Mahosot Hospital, MOH, Vientiane, Lao PDR
| | - Annelie Brauner
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Jo Durham
- Faculty of Health, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
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Boulom S, Bon DM, Essink D, Kounnavong S, Broerse JEW. Understanding Discrepancies in Nutritional Outcomes Among Under-Fives in Laos: A Mixed-Methods Study Using the Positive Deviance Approach. Food Nutr Bull 2022; 43:303-322. [PMID: 35506170 PMCID: PMC9403390 DOI: 10.1177/03795721221096187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/15/2022]
Abstract
BACKGROUND Stunting is one of the main contributing factors in the under-five mortality rate worldwide. In Laos, the prevalence of stunting remains high, particularly in mountainous rural areas. To prevent stunting, insight into positive deviant behaviors can help understand how people can cope or adapt in resource-poor settings. OBJECTIVE This study aims to analyze the practices and underlying factors that explain discrepancies in nutritional outcomes in children under the age of 5 in remote mountainous areas in Laos. METHODS This mixed-methods study included all children under the age of 5 living in 6 selected villages. Anthropometric measurements were taken, and a Z-score for stunting was calculated to select the positive and negative deviant children. To identify the causes of discrepancies in childhood stunting, household questionnaires, focus group discussions, observations, and individual interviews with family members and health workers were conducted. RESULTS Fifty-five percent of children were stunted. Inappropriate care and feeding practices were observed such as providing unbalanced diets and not attending health facilities. Positive deviant mothers were less likely to follow inappropriate practices, experienced less food insecurity, and had higher motivation and autonomy, which resulted in prioritizing their children's health. An active role of fathers seemed to benefit positive practices within households. CONCLUSIONS The combination of many different practices in which positive deviant families are doing slightly better resulted in less stunting of children. Those practices are related to the household resources, such as access to food and social support; and the mother's motivation, autonomy, and perspectives on child health.
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Affiliation(s)
- Sayvisene Boulom
- VU Amsterdam University, Amsterdam, the Netherlands.,National University of Laos, Vientiane, Lao PDR
| | | | - Dirk Essink
- VU Amsterdam University, Amsterdam, the Netherlands
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28
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Yan W, Machowska A, Sihavong A, Sychareun V, Chaleunvong K, Keohavong B, Eriksen J, Hanson C, Vongsouvath M, Brauner A, Mayxay M, Kounnavong S, Stålsby Lundborg C. Antibiotic Prescribing in Connection to Childbirth: An Observational Study in Two Districts in Lao PDR. Antibiotics (Basel) 2022; 11:antibiotics11040448. [PMID: 35453200 PMCID: PMC9029038 DOI: 10.3390/antibiotics11040448] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/21/2022] Open
Abstract
Overuse and misuse of antibiotics has frequently been reported for obstetric conditions and procedures, which may impact both the mother and the unborn baby and increase antibiotic resistance. This study aimed to investigate the antibiotic prescribing pattern in connection to childbirth in two districts in Lao PDR. It is a cross-sectional observational study. Antibiotic prescription data related to childbirth was collected via reviews of medical records in two district hospitals and five health centers in Lao PDR from September 2019 to November 2020. In total, antibiotic prescription data for 1777 women were extracted from their medical records. It was found that all women received antibiotics during in-patient care irrespective of delivery mode. When in hospital, 85.5% of the women who underwent a caesarean section got antibiotic treatment for 5 days and women who had a vaginal delivery usually had antibiotic treatment for one day or less. All the women got oral antibiotics for an additional 4–5 days upon discharge. Antibiotic prescription rate in connection to childbirth was very high in comparison with the WHO guidelines, and antibiotics were used extensively in the participating health facilities. Interventions to guide appropriate prescribing behavior in relation to childbirth are urgently needed in Lao PDR.
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Affiliation(s)
- Weirong Yan
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (A.M.); (J.E.); (C.H.); (C.S.L.)
- Correspondence:
| | - Anna Machowska
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (A.M.); (J.E.); (C.H.); (C.S.L.)
| | - Amphoy Sihavong
- Vientiane Capital Health Department, Ministry of Health, Vientiane 01030, Laos;
| | - Vanphanom Sychareun
- Faculty of Public Health, University of Health Sciences (UHS), Vientiane 7444, Laos;
| | - Kongmany Chaleunvong
- Institute of Research and Education Development, UHS, Ministry of Health, Vientiane 01030, Laos; (K.C.); (M.M.)
| | - Bounxou Keohavong
- Food and Drug Department, Ministry of Health, Vientiane 01030, Laos;
| | - Jaran Eriksen
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (A.M.); (J.E.); (C.H.); (C.S.L.)
- Department of Infectious Diseases/Venhalsan, Stockholm South General Hospital,118 83 Stockholm, Sweden
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (A.M.); (J.E.); (C.H.); (C.S.L.)
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Welcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane 01000, Laos;
| | - Annelie Brauner
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 77 Stockholm, Sweden;
- Division of Clinical Microbiology, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Mayfong Mayxay
- Institute of Research and Education Development, UHS, Ministry of Health, Vientiane 01030, Laos; (K.C.); (M.M.)
- Lao-Oxford-Mahosot Hospital-Welcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane 01000, Laos;
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford OX3 7LG, UK
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane 01030, Laos;
| | - Cecilia Stålsby Lundborg
- Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden; (A.M.); (J.E.); (C.H.); (C.S.L.)
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Oo MC, Phongluxa K, Oo WH, Kounnavong S, Xayyavong S, Louangphaxay C, Htike W, Cutts JC, Thu KM, Hkawng GN, Fowkes FJI. Perspectives of health and community stakeholders on community-delivered models of malaria elimination in Lao People’s Democratic Republic: A qualitative study. PLoS One 2022; 17:e0264399. [PMID: 35271594 PMCID: PMC8912149 DOI: 10.1371/journal.pone.0264399] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/10/2022] [Indexed: 11/22/2022] Open
Abstract
In the Lao People’s Democratic Republic (Lao PDR), village health volunteers play an important role in providing health services including those to reduce the burden of malaria. Over the last two decades, the volunteer network has expanded to bring malaria services closer to communities and contributed to the reduction of malaria cases. However, as malaria test positivity rates decreased, many volunteers have lost motivation to continue providing routine malaria services, and other services they provide may not reflect growing healthcare demands for common diseases in the community. This study explored the perspectives, knowledge and inputs of key health stakeholders and community members in southern Lao PDR on community-delivered models in order to refine the volunteer model in the context of Lao PDR’s primary health care sector and malaria elimination goals. Semi-structured interviews with multi-level health stakeholders, participatory workshops with community leaders, and focus group discussions with community members and current village health volunteers were conducted. Deductive followed by inductive thematic analysis was used to explore and categorise stakeholders’ perspectives on community-delivered models for malaria elimination. Both stakeholders and community members agreed that village health volunteers are essential providers of malaria services in rural communities. Apart from malaria, community members identified dengue, diarrhoea, influenza, skin infections and tuberculosis as priorities (in descending order of importance) and requested community-based primary health care for these diseases. Stakeholders and community members suggested integrating prevention, diagnosis, and treatment services for the five priority diseases into the current malaria volunteer model. A divergence was identified between community members’ expectations of health services and the services currently provided by village health volunteers. Stakeholders proposed an integrated model of healthcare to meet the needs of the community and help to maintain volunteers’ motivation and the long-term sustainability of the role. An evidence-based, integrated community-delivered model of healthcare should be developed to balance the needs of both community members and stakeholders, with consideration of available resources and current health policies in Lao PDR.
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Affiliation(s)
- May Chan Oo
- Health Security Program, Burnet Institute Myanmar, Yangon, Myanmar
- * E-mail: (MCO); (WHO)
| | | | - Win Han Oo
- Health Security Program, Burnet Institute Myanmar, Yangon, Myanmar
- Disease Elimination Program, Burnet Institute, Victoria, Australia
- * E-mail: (MCO); (WHO)
| | | | - Syda Xayyavong
- Lao Tropical and Public Health Institute, Vientiane, Lao PDR
| | | | - Win Htike
- Health Security Program, Burnet Institute Myanmar, Yangon, Myanmar
| | - Julia C. Cutts
- Disease Elimination Program, Burnet Institute, Victoria, Australia
| | - Kaung Myat Thu
- Health Security Program, Burnet Institute Myanmar, Yangon, Myanmar
| | - Galau Naw Hkawng
- Health Security Program, Burnet Institute Myanmar, Yangon, Myanmar
| | - Freya J. I. Fowkes
- Disease Elimination Program, Burnet Institute, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
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30
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Muramatsu-Noguchi Y, Nonaka D, Kounnavong S, Kobayashi J. Association Between Socio-Economic Status and the Presence of Soap at Handwashing Facilities in Lao People's Democratic Republic: A Cross-Sectional Study. Asia Pac J Public Health 2022; 34:423-426. [PMID: 35040349 PMCID: PMC9131397 DOI: 10.1177/10105395211072478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yuko Muramatsu-Noguchi
- Graduate School of Health Sciences, University of the Ryukyus, Okinawa, Japan.,Physical Fitness Research Institute Meiji Yasuda Life Foundation of Health and Welfare, Tokyo, Japan
| | - Daisuke Nonaka
- Graduate School of Health Sciences, University of the Ryukyus, Okinawa, Japan
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane Capital, Lao People's Democratic Republic
| | - Jun Kobayashi
- Graduate School of Health Sciences, University of the Ryukyus, Okinawa, Japan
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31
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Hinnouho GM, Hampel D, Shahab-Ferdows S, Barffour MA, McAnena L, Arnold CD, Ryan Wessells K, Kounnavong S, Allen LH, McNulty H, Hess SY. Daily supplementation of a multiple micronutrient powder improves folate but not thiamine, riboflavin, or vitamin B 12 status among young Laotian children: a randomized controlled trial. Eur J Nutr 2022; 61:3423-3435. [PMID: 35534778 PMCID: PMC9464137 DOI: 10.1007/s00394-022-02890-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/07/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the effects of intervention with a daily multiple micronutrient powder (MNP) on thiamine, riboflavin, folate, and B12 status among young Laotian children. METHODS Children (n = 1704) aged 6-23 mo, participating in a double-blind placebo-controlled randomized trial were individually randomized to receive daily either MNP (containing 0.5 mg of thiamine, 0.5 mg riboflavin, 150 μg folic acid, and 0.9 μg vitamin B12 along with 11 other micronutrients) or placebo and followed for ~ 36 weeks. In a randomly selected sub-sample of 260 children, erythrocyte thiamine diphosphate (eThDP), plasma folate and B12 concentrations, and erythrocyte glutathione reductase activation coefficient (EGRac; riboflavin biomarker) were assessed at baseline and endline. RESULTS There was no treatment effect on endline eThDP concentrations (110.6 ± 8.9 nmol/L in MNP vs. 109.4 ± 8.9 nmol/L in placebo group; p = 0.924), EGRac (1.46 ± 0.3 vs. 1.49 ± 0.3; p = 0.184) and B12 concentrations (523.3 ± 24.6 pmol/L vs. 515.9 ± 24.8 pmol/L; p = 0.678). Likewise, the prevalence of thiamine, riboflavin, and B12 deficiencies did not differ significantly between the two groups. However, endline folate concentration was significantly higher in the MNP compared to the placebo group (28.2 ± 0.8 nmol/L vs 19.9 ± 0.8 nmol/L, respectively; p < 0.001), and correspondingly, the prevalence of folate deficiency was significantly lower in the MNP group (1.6% vs 17.4%; p = 0.015). CONCLUSIONS Compared to a placebo, daily MNP for 9 months increased only folate but not thiamine, riboflavin, or B12 status in young Laotian children. TRIAL REGISTRATION The trial was registered at www. CLINICALTRIALS gov (NCT02428647) on April 29 2015.
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Affiliation(s)
- Guy-Marino Hinnouho
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA, USA. .,Helen Keller International, Washington, DC, USA.
| | - Daniela Hampel
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA USA ,USDA, ARS Western Human Nutrition Research Center, Davis, CA USA
| | | | - Maxwell A. Barffour
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA USA ,University of Missouri School of Medicine, Columbia, MO USA ,Public Health Program, College of Health and Human Services, Missouri State University, Springfield, MO USA
| | - Liadhan McAnena
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland UK
| | - Charles D. Arnold
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA USA
| | - K. Ryan Wessells
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA USA
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Vientiane, Lao People’s Democratic Republic
| | - Lindsay H. Allen
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA USA ,USDA, ARS Western Human Nutrition Research Center, Davis, CA USA
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland UK
| | - Sonja Y. Hess
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA USA
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32
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Mangkara B, Xaydalasouk K, Chanthavilay P, Kounnavong S, Sayasone S, Muller CP, Paboriboune P, Black AP. Hepatitis B virus in Lao dentists: A cross-sectional serological study. Ann Hepatol 2021; 22:100282. [PMID: 33217587 DOI: 10.1016/j.aohep.2020.10.010] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Hepatitis B virus (HBV) is endemic in Lao PDR, with up to 10% chronic infections in adults. Dentists have high risk of exposure and transmission to their patients. The aim was to investigate the serological profiles of vaccination, exposure and susceptibility to HBV. In addition, we determined the knowledge, attitude and practice (KAP) of Lao dentists toward HBV. MATERIALS AND METHODS Dentists and dental assistants were recruited from 186 private dental clinics in Vientiane Capital. They completed a KAP questionnaire and serum was tested by ELISA for HBV markers (anti-HB surface antigen, anti-core antigen, HBV surface antigen). RESULTS 206 dentists and 111 dental workers aged between 18-63 years were included. Serology data showed that 37.8% had previous exposure (49.0% of males and 32.4% of females) and 5.0% were chronically infected (7.7% of males and 3.8% of females). Less than 15% had serological evidence of vaccination and 66.8% were unprotected against infection. Knowledge of HBV was mostly low, for example 61.8% were aware of the childhood HBV vaccine. Just over half said that they should give dental care to HBV carriers. About one quarter reported accidental blood exposure during the last 6 months but knowledge about procedures after exposure was low. CONCLUSIONS Lao dentists are at high risk of occupational exposure to HBV but have low awareness and serological protection. There is a need to introduce mandatory vaccination, to strengthen occupational health in health care providers and to further develop the academic curricula of dental students.
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Affiliation(s)
- Bouasone Mangkara
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | | | - Phetsavanh Chanthavilay
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Somphou Sayasone
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Claude P Muller
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Phimpha Paboriboune
- Center of Infectiology Lao-Christophe Mérieux, Lao People's Democratic Republic
| | - Antony P Black
- Institut Pasteur du Laos, Vientiane, Lao People's Democratic Republic.
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Sychareun V, Sihavong A, Machowska A, Onthongdee X, Chaleunvong K, Keohavong B, Eriksen J, Hanson C, Vongsouvath M, Marrone G, Brauner A, Mayxay M, Kounnavong S, Lundborg CS. Knowledge, Attitudes, Perception and Reported Practices of Healthcare Providers on Antibiotic Use and Resistance in Pregnancy, Childbirth and Children under Two in Lao PDR: A Mixed Methods Study. Antibiotics (Basel) 2021; 10:antibiotics10121462. [PMID: 34943674 PMCID: PMC8698782 DOI: 10.3390/antibiotics10121462] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Overuse and misuse of antibiotics contribute unnecessarily to antibiotic resistance (ABR), and are thereby global health threats. Inappropriate prescriptions of antibiotics during pregnancy, delivery and early childhood are widespread across the world. This study aimed to assess knowledge, attitudes, and reported practices of healthcare providers (HCPs) and to explore their perceptions regarding antibiotic use and ABR related to pregnancy, childbirth, and children under two in Lao PDR. Methods: This is a mixed methods study with data collection in 2019 via structured interviews among 217 HCPs (medical doctors/assistant doctors, midwives/nurses, pharmacists/assistant pharmacists and drug sellers), who prescribed/dispensed antibiotics in one rural and one urban district in Vientiane province and individual qualitative interviews with 30 HCPs and stakeholders. Results: Of the HCPs, 36% had below average knowledge regarding antibiotic use and ABR, and 67% reported prescribing antibiotics for uncomplicated vaginal delivery. Half of the HCPs did not believe that their prescribing contributed to ABR, and only 9% had participated in antibiotic education. Conclusion: A substantial number of HCPs had suboptimal knowledge and prescribed antibiotics unnecessarily, thereby contributing to ABR. Continuous education and regular supervision of HCPs is recommended to improve the use of antibiotics related to pregnancy, childbirth, and young children.
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Affiliation(s)
- Vanphanom Sychareun
- Faculty of Public Health, University of Health Sciences (UHS), Vientiane 7444, Laos;
| | - Amphoy Sihavong
- Vientiane Capital Health Department, Ministry of Health, Vientiane 01030, Laos;
| | - Anna Machowska
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden; (J.E.); (C.H.); (G.M.); (C.S.L.)
- Correspondence:
| | - Xanded Onthongdee
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane 01030, Laos; (X.O.); (S.K.)
| | - Kongmany Chaleunvong
- Institute of Research and Education Development, UHS, Ministry of Health, Vientiane 01030, Laos; (K.C.); (M.M.)
| | - Bounxou Keohavong
- Food and Drug Department, Ministry of Health, Vientiane 01030, Laos;
| | - Jaran Eriksen
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden; (J.E.); (C.H.); (G.M.); (C.S.L.)
- Department of Infectious Diseases/Venhalsan, Stockholm South General Hospital, 11883 Stockholm, Sweden
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden; (J.E.); (C.H.); (G.M.); (C.S.L.)
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Welcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane 01000, Laos;
| | - Gaetano Marrone
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden; (J.E.); (C.H.); (G.M.); (C.S.L.)
| | - Annelie Brauner
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 17177 Stockholm, Sweden;
- Division of Clinical Microbiology, Karolinska University Hospital, 17164 Solna, Sweden
| | - Mayfong Mayxay
- Institute of Research and Education Development, UHS, Ministry of Health, Vientiane 01030, Laos; (K.C.); (M.M.)
- Lao-Oxford-Mahosot Hospital-Welcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane 01000, Laos;
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford OX3 7LG, UK
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane 01030, Laos; (X.O.); (S.K.)
| | - Cecilia Stålsby Lundborg
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden; (J.E.); (C.H.); (G.M.); (C.S.L.)
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Takahashi E, Vilay P, Chanthakoummane K, Pongvongsa T, Kounnavong S, Kano S, Kobayashi J, Nonaka D. Adherence to antihypertensive medications in rural Lao PDR: a prospective observational study. Trop Med Health 2021; 49:88. [PMID: 34715938 PMCID: PMC8556995 DOI: 10.1186/s41182-021-00374-4] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022] Open
Abstract
Background Although hypertension is becoming more prevalent among the adult population of the Lao People’s Democratic Republic (PDR), with a prevalence of approximately 20% in 2013, treatment adherence of patients with hypertension, especially those in rural areas, remains poorly understood. The objective of the present study was to examine the rate of medication adherence to antihypertensive medicines among outpatients with hypertension in rural districts of the Savannakhet. Methods A prospective observational study was conducted in Xepon, Phin, and Nong districts. The study population was outpatients aged 18 years or older who were prescribed antihypertensive medicines at three district hospitals between February and August 2017. Data were collected on the first day of treatment (day 0) and the day of follow-up (around day 7) through interviews with the patients and outpatient registration books. The medication adherence rate was determined using the four-item Morisky Medication Adherence Scale. The level of adherence was evaluated by the sum of the scale, with scores ranging from 0 to 4 points. The adherent group, namely those with a score of 0, and the non-adherent group, namely those with scores of 1 to 4 points, were compared. Fisher’s exact test was used to identify factors associated with medication adherence. Results Of the 68 patients examined, 38.2% newly began treatment. Half of the patients (n = 34, 50.0%, 95% CI 0.38 to 0.62) adhered to medication instructions. The adherent group was more likely to have received written instructions when prescribed medication, compared to the non-adherent group (79.4% vs 55.9%, p = 0.068). Those who perceived that hypertension needs lifelong treatment were significantly more likely to adhere to the medication regimen (p = 0.028). Conclusions Medication adherence was present among 50% of outpatients with hypertension who visited a district hospital. Therefore, providing written instructions to patients would be effective for improving medication adherence.
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Affiliation(s)
- Emiri Takahashi
- Faculty of Pharmacy, Takasaki University of Health and Welfare, Takasaki, Gunma, Japan.
| | - Phoutnalong Vilay
- Center of Malariology, Parasitology and Entomology, Ministry of Health, Vientiane, Lao PDR
| | | | - Tiengkham Pongvongsa
- Savannakhet Provincial Health Department, Savannakhet, Lao PDR.,Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao PDR
| | - Shigeyuki Kano
- Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Jun Kobayashi
- Department of Global Health, Graduate School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Daisuke Nonaka
- Department of Global Health, Graduate School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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Smith TJ, Tan X, Arnold CD, Sitthideth D, Kounnavong S, Hess SY. Traditional prenatal and postpartum food restrictions among women in northern Lao PDR. Matern Child Nutr 2021; 18:e13273. [PMID: 34595830 PMCID: PMC8710103 DOI: 10.1111/mcn.13273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/28/2021] [Accepted: 09/01/2021] [Indexed: 11/04/2022]
Abstract
Culturally determined food restrictions are common among pregnant and postpartum women in Asia. This study aimed to describe perinatal dietary restrictions, factors associated with food avoidances and attainment of minimum dietary diversity (MDD‐W) among women in Lao PDR. Mother–child (aged 21 days to <18 months) dyads (n = 682) were enrolled into a cohort study in northern Lao PDR and interviewed at one time point postpartum. During pregnancy and postpartum, 1.6% and 97% of women reported following dietary restrictions, respectively. Cluster analysis identified four distinct postpartum dietary patterns: most restrictive (throughout first 2 months postpartum); least restrictive; 2 weeks highly restrictive and 1 month highly restrictive, followed by 19%, 15%, 5% and 62% of women, respectively. Greater maternal age, gravidity and higher household socioeconomic status were associated with allowing more diverse foods, while women from food insecure households followed more restrictive diets for longer. Women belonging to the Hmong ethnic group followed a highly restrictive diet of white rice and chicken for the first month postpartum. MDD‐W was achieved by 10% of women restricting their diet at the time of the interview compared with 17% of women who were consuming their normal diet (p = 0.04). Postpartum dietary restrictions are widespread among women in northern Lao PDR. These highly restrictive diets, low dietary diversity and food insecurity likely contribute to micronutrient deficiencies in women that may have important consequences for their breastfed infants through reduced breastmilk micronutrient content, which requires further exploration. Culturally appropriate strategies to increase micronutrient intakes among women should be considered.
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Affiliation(s)
- Taryn J Smith
- Institute for Global Nutrition, University of California Davis, Davis, California, USA
| | - Xiuping Tan
- Institute for Global Nutrition, University of California Davis, Davis, California, USA
| | - Charles D Arnold
- Institute for Global Nutrition, University of California Davis, Davis, California, USA
| | - Dalaphone Sitthideth
- Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic
| | - Sonja Y Hess
- Institute for Global Nutrition, University of California Davis, Davis, California, USA
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Wallenborn JT, Valera CB, Kounnavong S, Sayasone S, Odermatt P, Fink G. Urban-Rural Gaps in Breastfeeding Practices: Evidence From Lao People's Democratic Republic. Int J Public Health 2021; 66:1604062. [PMID: 34566553 PMCID: PMC8458572 DOI: 10.3389/ijph.2021.1604062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/02/2021] [Accepted: 08/20/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives: Breastfeeding rates are decreasing rapidly in many low and middle-income countries, disproportionately affecting urban residences. We use data from Lao People’s Democratic Republic to identify primary mechanisms underlying the urban-rural gap in breastfeeding practices. Methods: We used data from the 2017 Lao Social Indicator Survey II. Residence was categorized as large-urban (>1 million), small-urban (<1 Million), and rural. Multivariable logistic regression provided odds ratios and 95% confidence intervals (CI) to identify factors attributing to the urban-rural differences in complying with World Health Organization’s breastfeeding recommendations for children <24 months. Results: Mothers in large-urban residences had 3.78 (95% confidence intervals: 1.19, 11.95) and 4.67 (95% CI: 2.30, 9.46) higher odds of non-compliance with exclusive and complementary breastfeeding recommendations, respectively, than mothers living in rural areas in bivariate models. Breastfeeding differentials between small urban and rural residences were largely explained by differences in maternal education and household wealth. Conclusion: Results of our paper suggest large disparities in breastfeeding practices between large-urban, small-urban, and rural residences.
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Affiliation(s)
- Jordyn T Wallenborn
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Camille B Valera
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | | | - Peter Odermatt
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,University of Basel, Basel, Switzerland
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Mizuno Y, Masuoka H, Kibe M, Kosaka S, Natsuhara K, Hirayama K, Inthavong N, Kounnavong S, Tomita S, Umezaki M. Impact of modernization on urinary concentrations of arsenic, cadmium, lead, and selenium in rural residents of Northern Laos. Am J Hum Biol 2021; 34:e23685. [PMID: 34564914 DOI: 10.1002/ajhb.23685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The impacts of modernization on toxic heavy metal exposure and essential trace element intake in indigenous populations of subsistence societies are unknown. We assessed urinary trace element concentrations in rural residents of Northern Laos and examined associations with levels of modernization. METHODS A cross-sectional study was conducted comprising 380 residents of three villages in Northern Laos with different levels of modernization. We surveyed general characteristics and measured the weight and height of 341 participants. Arsenic, cadmium, lead, and selenium concentrations were measured in spot urine samples by inductively coupled plasma mass spectrometry. We examined associations between urinary trace element concentrations and variables related to modernization (village, roofing material, possessions index [total number of possessions], and body mass index [BMI]) using multilevel analyses with household as a random effect, after adjusting for sex, age, and smoking status. RESULTS Urinary concentrations of arsenic and cadmium were high, while those of lead and selenium were low in comparison to previous reports of populations in non-contaminated regions or without excess/deficiency. We observed associations between urinary trace element concentrations and village-level modernization: lead and selenium concentrations were higher in more modernized villages and cadmium concentration was highest in the least modernized village. Urinary arsenic concentration was not predicted by the modernization level of a village, although we observed significant differences among villages. In addition, urinary selenium concentration was higher in participants inhabiting more modernized houses. CONCLUSION Modernization of villages may impact toxic heavy metal exposure and selenium intake in rural residents of Northern Laos.
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Affiliation(s)
- Yuki Mizuno
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Masuoka
- RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Mihoko Kibe
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoko Kosaka
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Kazuhiro Hirayama
- Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Nouhak Inthavong
- Ministry of Health, Lao Tropical and Public Health Institute, Vientiane, Laos
| | | | - Shinsuke Tomita
- Graduate School of Environmental Studies, Nagoya University, Nagoya, Japan
| | - Masahiro Umezaki
- Department of Human Ecology, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Jiang H, Lin L, Yonto DA, Pongvongsa T, Kounnavong S, Moji K. Association between physical activity and activity space in different farming seasons among rural Lao PDR residents. Trop Med Health 2021; 49:73. [PMID: 34530922 PMCID: PMC8444593 DOI: 10.1186/s41182-021-00364-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 09/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Southeast Asia is experiencing a health transition, where non-communicable diseases (NCD) are exceeding communicable diseases. Despite NCDs accounting for roughly 60–85% of deaths in the region, many developing Southeast Asian countries are beginning to address the impacts of a physically inactive lifestyle for the first time. Our study aims to bridge this gap by objectively measuring physical activity in rural Lao PDR to reveal the association among physical activity, activity space, and seasonal variation. Methods Multiple waves of survey data were collected in Songkhon District, Lao PDR between March 2010 and March 2011. Adults aged between 18 and 65 were recruited (n = 48). A portable GPS recorded participants’ activity and farmland locations and an accelerometer recorded participants’ physical activity level and daily steps for seven consecutive days. Using a directional distribution tool in ArcGIS 10.5, the activity space area of each participant in each wave was calculated. Concurrently, participants recorded time spent on each daytime activity. Linear mixed models with the fixed effects as the observations from different waves and the random effects as individual participants were developed to identify factors associated with areas of activity space and counts of daily steps, respectively. Results A total of 48 respondents aged between 19 and 57 took part in the study. Half of the participants were females. Walking was found to be the most frequent travel mode. Females were physically less active, with a smaller activity space, and were more overweight than the males in the study. Participants were physically less active during the off-farming seasons. Conclusions Findings contribute to the surveillance of risk factors needed to create healthy living environments. Our research is also one of the first to use empirical evidence demonstrating seasonal variations of rural residents’ activities in mainland Southeast Asia. Supplementary Information The online version contains supplementary material available at 10.1186/s41182-021-00364-6.
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Affiliation(s)
- Hongwei Jiang
- Research Institute for Humanity and Nature, 457-4 Motoyama, Kamigamo, Kita-ku, Kyoto, 603-8047, Japan.
| | - Lin Lin
- Department of Urban Planning and Design, Xi'an Jiaotong - Liverpool University, Suzhou, Jiangsu Province, China
| | | | - Tiengkham Pongvongsa
- Savannakhet Provincial Health Department, Savannakhet city, Savannakhet Province, Lao PDR
| | | | - Kazuhiko Moji
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki City, Japan
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Kawaguchi Y, Sayed AM, Shafi A, Kounnavong S, Pongvongsa T, Lasaphonh A, Xaylovong K, Sato M, Matsui M, Imoto A, Huy NT, Moji K. Factors affecting the choice of delivery place in a rural area in Laos: A qualitative analysis. PLoS One 2021; 16:e0255193. [PMID: 34339442 PMCID: PMC8328292 DOI: 10.1371/journal.pone.0255193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/11/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Home delivery (HD) without skilled birth attendants (SBAs) are considered crucial risk factors increasing maternal and child mortality rates in Loa PDR. While a few studies in the literature discuss the choice of delivery in remote areas of minority ethnic groups; our work aims to identify factors that indicated their delivery place, at home or in the health facilities. METHODS A community-based qualitative study was conducted between February and March 2020. Three types of interviews were implemented, In-depth interviews with 16 women of eight rural villages who delivered in the last 12 months in Xepon District, Savannakhet Province, Lao PDR. Also, three focus group discussions (FGDs) with nine HCPs and key-informant interviews of ten VHVs were managed. Factors affecting the choice of the delivery place were categorized according to the social-ecological model. RESULTS Our sample included five Tri women and two Mangkong women in the HD group, while the FD group included three Tri women, two Mangkong women, one Phoutai woman, two Laolung women and one Vietnamese. Our investigation inside the targeted minority showed that both positive perceptions of home delivery (HD) and low-risk perception minorities were the main reasons for the choice of HD, on the individual level. On the other hand, fear of complication, the experience of stillbirth, and prolonged labour pain during HD were reasons for facility-based delivery (FD). Notably, the women in our minority reported no link between their preference and their language, while the HCPs dated the low knowledge to the language barrier. On the interpersonal level, the FD women had better communication with their families, and better preparation for delivery compared to the HD group. The FD family prepared cash and transportation using their social network. At the community level, the trend of the delivery place had shifted from HD to FD. Improved accessibility and increased knowledge through community health education were the factors of the trend. At the societal (national policy) level, the free delivery policy and limitation of HCPs' assisted childbirth only in health facilities were the factors of increasing FD, while the absence of other incentives like transportation and food allowance was the factor of remaining of HD. CONCLUSIONS Based on the main findings of this study, we urge the enhancement of family communication on birth preparedness and birthplace. Furthermore, our findings support the need to educate mothers, especially those of younger ages, about their best options regarding the place of delivery. We propose implementing secondary services of HD to minimize the emergency risks of HD. We encourage local authorities to be aware of the medical needs of the community especially those of pregnant females and their right for a free delivery policy.
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Affiliation(s)
- Yoshiko Kawaguchi
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Ahmad M. Sayed
- Department of Organic Chemistry, College of Pharmacy, Al-Azhar University, Cairo, Egypt
- Online Research Club (https://www.onlineresearchclub.org/), Nagasaki, Japan
| | - Alliya Shafi
- Online Research Club (https://www.onlineresearchclub.org/), Nagasaki, Japan
- School of Medicine, American University of Caribbean, Sint Maarten
| | | | | | | | - Khamsamay Xaylovong
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Miho Sato
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Mitsuaki Matsui
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Atsuko Imoto
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Online Research Club (https://www.onlineresearchclub.org/), Nagasaki, Japan
- * E-mail: (NTH); (KM)
| | - Kazuhiko Moji
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- * E-mail: (NTH); (KM)
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Virachith S, Pommelet V, Calvez E, Khounvisith V, Sayasone S, Kounnavong S, Mayxay M, Xangsayarath P, Temmam S, Eloit M, Escriou N, Rose T, Vongphayloth K, Hübschen JM, Lacoste V, Somlor S, Phonekeo D, Brey PT, Black AP. Low seroprevalence of COVID-19 in Lao PDR, late 2020. Lancet Reg Health West Pac 2021; 13:100197. [PMID: 34278365 PMCID: PMC8277598 DOI: 10.1016/j.lanwpc.2021.100197] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/24/2021] [Accepted: 06/06/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND In 2020 Lao PDR had low reported COVID-19 cases but it was unclear whether this masked silent transmission. A seroprevalence study was done August - September 2020 to determine SARS-CoV-2 exposure. METHODS Participants were from the general community (n=2433) or healthcare workers (n=666) in five provinces and bat/wildlife contacts (n=74) were from Vientiane province. ELISAs detected anti- SARS-CoV-2 Nucleoprotein (N; n=3173 tested) and Spike (S; n=1417 tested) antibodies. Double-positive samples were checked by IgM/IgG rapid tests. Controls were confirmed COVID-19 cases (n=15) and pre-COVID-19 samples (n=265). Seroprevalence for the general community was weighted to account for complex survey sample design, age and sex. FINDINGS In pre-COVID-19 samples, 5·3%, [95% CI=3·1-8·7%] were anti-N antibody single-positive and 1·1% [0·3-3·5%] were anti-S antibody single positive. None were double positive. Anti-N and anti-S antibodies were detected in 5·2% [4·2-6·5%] and 2·1% [1·1-3·9%] of the general community, 2·0% [1·1-3·3%] and 1·4% [0·5-3·7%] of healthcare workers and 20·3% [12·6-31·0%] and 6·8% [2·8-15·3%] of bat/wildlife contacts. 0·1% [0·02-0·3%] were double positive for anti-N and anti-S antibodies (rapid test negative). INTERPRETATION We find no evidence for significant SARS-CoV-2 circulation in Lao PDR before September 2020. This likely results from early decisive measures taken by the government, social behavior, and low population density. High anti-N /low anti-S seroprevalence in bat/wildlife contacts may indicate exposure to cross-reactive animal coronaviruses with threat of emerging novel viruses. FUNDING Agence Française de Développement. Additional; Institut Pasteur du Laos, Institute Pasteur, Paris and Luxembourg Ministry of Foreign and European Affairs ("PaReCIDS II").
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Affiliation(s)
| | | | - Elodie Calvez
- Institut Pasteur du Laos, Vientiane Capital, Lao PDR
| | | | - Somphou Sayasone
- Lao Tropical Public Health Institute, Vientiane Capital, Lao PDR
| | | | - Mayfong Mayxay
- Institute of Research and Education Development (IRED), University of Health Sciences, Ministry of Health, Vientiane, Lao PDR
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine & Global Health, University of Oxford, UK
| | | | - Sarah Temmam
- Pathogen Discovery Laboratory, Institut Pasteur, Paris, France
| | - Marc Eloit
- Pathogen Discovery Laboratory, Institut Pasteur, Paris, France
- Ecole Nationale Vétérinaire d'Alfort, Maisons Alfort, France
| | | | - Thierry Rose
- Lymphocyte Cell Biology Unit, INSERM 1221, Institut Pasteur, Paris, France
| | | | | | | | | | | | - Paul T. Brey
- Institut Pasteur du Laos, Vientiane Capital, Lao PDR
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Smith T, Tan X, Arnold C, Sitthideth D, Kounnavong S, Hess S. Strategies to Increase Micronutrient Intakes Among Laotian Women Adhering to Traditional Postpartum Dietary Restrictions. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab046_116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Culturally determined restrictive postpartum diets are common in Lao PDR, placing lactating women and breastfed infants at high risk of micronutrient deficiencies. The objective of this analysis was to explore if fortified condiments and supplements would be suitable strategies to improve micronutrient intakes among women adhering to dietary restrictions.
Methods
Mother-child (aged 21 days - <18 months) dyads (n = 680) were enrolled into a prospective cohort study in Lao PDR. Women were interviewed about foods and condiments that were consumed or restricted in weekly (for the first four weeks) and monthly intervals postpartum, and if they would be willing to take supplements during this time if provided to them. Data on minimum dietary diversity for women (MDD-W) and household food insecurity was collected.
Results
Mean ± SD child and maternal age was 4.3 ± 3.3 mo and 24.7 ± 6.3 yr respectively, 95% of mothers were breastfeeding and 34% of households were moderately to severely food insecure. Almost all women (97%) reported adhering to food restrictions after childbirth for a median (IQR) length of time of 1 (1, 3) month (range 1 week to 36 months). White rice was consumed universally postpartum, however other diverse foods were highly restricted and consumed by < 32% of women in the first month. MDD-W was achieved by 10.4% of women currently restricting their diet and 16.4% who had resumed/were consuming their normal diet (p = 0.04). Of the women interviewed about condiments (n = 480), 99%, 43% and 53% habitually consumed salt, fish sauce and soy sauce respectively. During the period of dietary restrictions, 54% and 38% of habitual consumers restricted fish and soy sauces respectively, while all women continued to consume salt. Of the women asked about supplement use (n = 415), 87% reported that they would take supplements during the period of dietary restrictions.
Conclusions
Postpartum dietary restrictions are widespread among women in Lao PDR. These highly restrictive diets and low dietary diversity likely contribute to micronutrient deficiencies in mothers that may have important consequences for their breastfed infants through reduced micronutrient content of breastmilk, which requires further exploration. Salt fortification and supplements could be viable strategies to increase micronutrient intakes among women.
Funding Sources
Bill & Melinda Gates Foundation.
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Affiliation(s)
| | | | - Charles Arnold
- Institute for Global Nutrition, University of California, Davis
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Toyama N, Vongphoumy I, Uehara M, Sato C, Nishimoto F, Moji K, Pongvongsa T, Shirai K, Takayama T, Takahara M, Tamashiro Y, Endo Y, Kounnavong S, Kobayashi J. Impact of village health volunteer support on postnatal depressive symptoms in the remote rural areas of Lao People's Democratic Republic: a cross-sectional study. Trop Med Health 2021; 49:28. [PMID: 33785051 PMCID: PMC8010948 DOI: 10.1186/s41182-021-00316-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/15/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Village health volunteers (VHVs) are responsible for providing primary care in the communities of Laos. Unlike other districts, in Xepon more than 90% of VHVs are male and therefore experience difficulties interacting with pregnant women. To improve outreach to pregnant women, especially among ethnic minorities, a new project was implemented by local municipalities in 2017: newly selected female VHVs were paired to work with existing male VHVs. The objective of this study was to compare the postnatal depressive symptoms of ethnic minority mothers supported by pair-VHVs and single-VHVs in remote rural areas of Lao People's Democratic Republic (PDR). METHODS A cross-sectional study was conducted in March 2019. Mothers who had delivered a baby within 1 year preceding the study were recruited from 36 villages. Of the 305 mothers, 227 responded. The questionnaires included (1) demographic characteristics such as age, economic status, and birth experience; (2) self-decision to go to a health center/hospital to receive antenatal care; (3) type of VHVs (pair or single), support, and information from VHVs during pregnancy, support from husband and relationship with husband; (4) the Edinburgh Postnatal Depression Scale (EPDS). A Mann-Whitney U test, chi-square test, and multiple linear regression analysis were performed. Ethical approval was obtained from the University of the Ryukyus and National Ethics Committee for Health Research of Lao PDR. RESULTS The average total EPDS score was 5.5 among mothers supported by pair-VHV and 7.0 among mothers supported by single-VHV. Results of the multiple linear regression analysis showed that the EPDS score was significantly lower among mothers supported by pair-VHV (β=-1.18, p <0.05) even after adjusting for economic and biological factors. CONCLUSIONS Mothers supported by pair-VHV had a significantly lower EPDS score than those supported by single-VHVs in this study area, suggesting that the support of male and female VHV pairs contributed to improving mental health status among ethnic minority mothers in remote rural areas of Lao PDR. Expanding the program to train female VHVs working with male VHVs is necessary for improving maternal and child health in a rural district of Lao PDR.
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Affiliation(s)
- Noriko Toyama
- School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
| | | | - Manami Uehara
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Okinawa, Japan
| | - Chika Sato
- Asia Health and Education Fund, Tokyo, Japan
| | - Futoshi Nishimoto
- Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan
| | - Kazuhiko Moji
- Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan
| | - Tiengkham Pongvongsa
- Savannakhet Provincial Health Department, Savannakhet, Lao People's Democratic Republic
| | - Kokoro Shirai
- Department of Public Health, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomomi Takayama
- School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Misuzu Takahara
- School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yoko Tamashiro
- School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yumiko Endo
- School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Jun Kobayashi
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Okinawa, Japan
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Keokenchanh S, Kounnavong S, Midorikawa K, Ikeda W, Morita A, Kitajima T, Sokejima S. Prevalence of anemia and its associated factors among children aged 6-59 months in the Lao People's Democratic Republic: A multilevel analysis. PLoS One 2021; 16:e0248969. [PMID: 33765048 PMCID: PMC7993607 DOI: 10.1371/journal.pone.0248969] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/08/2021] [Indexed: 11/19/2022] Open
Abstract
Anemia is a major public health concern among children aged <5 years in the Lao People’s Democratic Republic. Thus far, no study has determined the factors associated with anemia among children aged <5 years in the Lao People’s Democratic Republic using a nationwide representative sample. Therefore, this study aimed to evaluate the prevalence of anemia and its associated factors with multilevel variations among children aged 6–59 months. This quantitative, cross-sectional study used a nationally representative sample from the Lao Social Indicator Survey II, 2017. Children aged 6–59 months tested for anemia were included in this study through multistage sampling approaches. Anemia was defined as a hemoglobin level of <11.0 g/dL. Multilevel binary logistic regression analyses were used to determine the adjusted effect of the factors associated with anemia. Among the 5,087 children included, the overall prevalence of anemia was 43.0%. Three factors were associated with higher odds of developing anemia—male sex (adjusted odds ratio, 1.16; 95% confidence interval, 1.01–1.34), underweight (adjusted odds ratio, 1.30; 95% confidence interval, 1.09–1.55), and residence in central provinces (adjusted odds ratio, 1.59; 95% confidence interval, 1.30–1.95) and southern provinces (adjusted odds ratio, 1.42; 95% confidence interval, 1.11–1.81). However, the other three factors—age, educational level of the household head, and Hmong-Mien ethnicity—were inversely associated with anemia. To resolve the problem regarding the severity of the anemia among children aged <5 years in the Lao People’s Democratic Republic. Our findings highlight the need for designing an effective approach to address each factor associated with childhood anemia. Interventions should focus on the prevention of childhood anemia, which is considered a major priority of public health intervention in the Lao People’s Democratic Republic.
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Affiliation(s)
- Sengtavanh Keokenchanh
- Department of Public Health and Occupational Medicine, Mie University Graduate School of Medicine, Tsu-shi, Mie, Japan
- Foreign Relation Division, Cabinet of the Ministry of Health, Sisattanack District, Vientiane Capital, Lao PDR
- * E-mail:
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Sisattanack district, Vientiane Capital, Lao PDR
| | - Kaoru Midorikawa
- Faculty of Child Education, Suzuka University, Suzuka, Mie, Japan
| | - Wakaha Ikeda
- Epidemiology Centre for Disease Control and Prevention, Mie University Hospital, Tsu-shi, Mie, Japan
| | - Akemi Morita
- Department of Public Health and Occupational Medicine, Mie University Graduate School of Medicine, Tsu-shi, Mie, Japan
| | - Takumi Kitajima
- Department of Public Health and Occupational Medicine, Mie University Graduate School of Medicine, Tsu-shi, Mie, Japan
| | - Shigeru Sokejima
- Department of Public Health and Occupational Medicine, Mie University Graduate School of Medicine, Tsu-shi, Mie, Japan
- Epidemiology Centre for Disease Control and Prevention, Mie University Hospital, Tsu-shi, Mie, Japan
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Boulom S, Essink DR, Kang MH, Kounnavong S, Broerse JEW. Factors associated with child malnutrition in mountainous ethnic minority communities in Lao PDR. Glob Health Action 2021; 13:1785736. [PMID: 32741342 PMCID: PMC7480462 DOI: 10.1080/16549716.2020.1785736] [Citation(s) in RCA: 6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background Although in many low- and middle-income countries undernutrition is steadily decreasing, nutritional challenges persist in remote communities, such as those in mountainous areas of Lao PDR. Isolated, with limited access to food and to health care and other public services, local diets are low in both quantity and diversity. Data needed to guide policy and planning are lacking. Objectives The study aimed to identify the extent of malnutrition and associated factors among children aged 12–47 months in remote mountainous communities in Lao PDR. Methods A cross-sectional survey was conducted in Nong district, Savannakhet province, covering 173 households, involving heads of households, mothers and their children aged 12–47 months. Results The prevalence of undernutrition was very high among the 173 children studied: 72.8% were stunted, 50.3% underweight and 10.4% wasted. Key factors showing significant positive associations with nutritional status were assets (mobile phone or electric rice mill), collection of non-timber forest products, and household dietary diversity. Negative associations were found with experience of malaria and consuming high amounts of white roots and tubers. Immediate causes of malnutrition were prevalent; half the children had insufficient consumption of all micro- and macronutrients. Diseases were highly prevalent; 30% had recently experienced fever. The households in these villages were quite homogeneous. All scored high on causes of malnutrition; 90% of households experienced food insecurity, nearly all lived below the poverty line, and almost two-thirds of household heads and nearly all mothers had had no education. Conclusion This study identified multiple factors influencing child malnutrition, including low household food diversity, food insecurity, and poor feeding practices among ethnic minority people living in a difficult environment with limited resources. Child undernutrition in these poor communities is complex. Interventions are needed in different sectors, including agricultural production, knowledge on feeding and health services.
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Affiliation(s)
- Sayvisene Boulom
- Rural Economic and Food Technology Department, Faculty of Agriculture, National University of Laos , Vientiane, Lao PDR.,Athena Institute, Faculty of Science, Vrije Universiteit , Amsterdam, Netherlands
| | - Dirk R Essink
- Athena Institute, Faculty of Science, Vrije Universiteit , Amsterdam, Netherlands
| | - Myung-Hee Kang
- Rural Economic and Food Technology Department, Faculty of Agriculture, National University of Laos , Vientiane, Lao PDR
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Phongluxa K, Langeslag G, Jat TR, Kounnavong S, Khan MA, Essink DR. Factors influencing sexual and reproductive health among adolescents in Lao PDR. Glob Health Action 2021; 13:1791426. [PMID: 32741350 PMCID: PMC7480507 DOI: 10.1080/16549716.2020.1791426] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/23/2022] Open
Abstract
Background Adolescents are particularly vulnerable to poor sexual and reproductive health outcomes. In addition, Lao PDR has the highest teenage pregnancy rate in southeast Asia and a high maternal mortality ratio. Objective This study aimed to provide a comprehensive exploration of factors that influence SRH knowledge, attitudes, and practices of adolescents in Bokeo Province, Lao PDR. Method Data from the Adolescent Girl Situation Analysis cross-sectional study, collected in 2018 using a mixed-method approach with 837 adolescents aged 10–19, and key informant interviews, were analysed. Regression analyses were used to identify predictors of modern contraception knowledge, autonomy, gender-based violence, sexual activity, and contraception use. This was complemented with qualitative thematic content analysis. Results Adolescents living in two rural districts had lower sexual and reproductive health knowledge compared to urban district residents. Findings showed misconceptions about the birth control pill, a belief that sex education is important, but that the current teaching quality is problematic. There was a strong positive association between knowledge and autonomy. In the two rural districts, residents were more likely to lack autonomy. Marriage was described as an autonomous decision, yet 40.4% lacked autonomy regarding marriage. Among sexually active adolescents, 35.2% used contraception. Boys and girls were said to be equal, yet education access and gender roles favoured boys. Additionally, violence was more justified by husbands against their wives. Conclusion The study helps to understand the views and perceptions of adolescents and key informants on gender equality and gender-based violence. Three main areas require more effort and greater investment to improve adolescent sexual and reproductive health: knowledge and use of contraceptives, gender inequality, and autonomy. There is poor knowledge of contraceptive methods, indicating a need to further integrate comprehensive sexual education, introduced in primary school, and to increase investment in training and monitoring teachers.
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Affiliation(s)
- Khampheng Phongluxa
- Lao Tropical and Public Health Institute, Ministry of Health , Vientiane, Lao PDR
| | - Ghislaine Langeslag
- Athena Institute, Faculty of Earth and Life Sciences, Vrije Universiteit Van Amsterdam , Amsterdam, The Netherlands
| | - Tej Ram Jat
- United Nations Population Fund (UNFPA) , Vientiane, Lao PDR
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health , Vientiane, Lao PDR
| | - Mariam A Khan
- United Nations Population Fund (UNFPA) , Vientiane, Lao PDR
| | - Dirk R Essink
- Athena Institute, Faculty of Earth and Life Sciences, Vrije Universiteit Van Amsterdam , Amsterdam, The Netherlands
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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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Barffour MA, Hinnouho GM, Wessells KR, Kounnavong S, Ratsavong K, Sitthideth D, Bounheuang B, Sengnam K, Chanhthavong B, Arnold CD, Brown KH, Larson CP, Hess SY. Effects of therapeutic zinc supplementation for diarrhea and two preventive zinc supplementation regimens on the incidence and duration of diarrhea and acute respiratory tract infections in rural Laotian children: A randomized controlled trial. J Glob Health 2021; 10:010424. [PMID: 32612816 PMCID: PMC7321011 DOI: 10.7189/jogh.10.010424] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Diarrhea and respiratory tract infections are leading causes of childhood morbidity and mortality. This individually randomized, double-blind placebo-controlled trial was designed to evaluate the effects of different zinc supplementation regimens on the incidence and duration of diarrhea and acute lower (ALRI) and upper (AURI) respiratory tract infections among rural Laotian children. The study included 3407 children, 6-23 months at enrollment. Methods Children were randomized to one of four study groups: therapeutic zinc supplements for diarrhea treatment (20 mg/d for 10 days with each episode; TZ), daily preventive zinc tablets (7 mg/d; PZ), daily multiple micronutrient powder (10 mg/d zinc, 6 mg/d iron and 13 other micronutrients; MNP), or daily placebo powder for 9 months. Incidence and duration of diarrhea (≥3 liquid stools/24 hours), ALRI (persistent cough with wheezing, stridor or chest in-drawing) and AURI (purulent nasal discharge with cough) were assessed by parental report during weekly home visits and analyzed using negative binomial models. Results Baseline mean age was 14.2 ± 5.1 months, and 71% had low plasma zinc (<65 μg/dL). Overall diarrhea incidence (0.61 ± 0.01 episodes/100 days at risk) and duration (2.12 ± 0.03 days/episode) did not differ by study group. Age modified the impact of the interventions on diarrhea incidence (P = 0.06) and duration (P = 0.01). In children >18 months, TZ reduced diarrhea incidence by 24% vs MNP (P = 0.035), and 36% vs Control (P = 0.004), but there was no difference with PZ. This patterned remained when analyses were restricted to diarrhea episode occurring after the first treatment with TZ. Also, in children >18 months, TZ reduced diarrhea duration by 15% vs PZ (P = 0.03), and 16% vs Control (P = 0.03), but there was no difference with MNP. There were no overall effects of study group on incidence of ALRI (overall mean 0.005 ± 0.001 episodes/100 days, P = 0.14) or AURI (overall mean 0.09 ± 0.01 episodes/100 days, P = 0.72). Conclusions There was no overall impact of TZ, PZ or MNP on diarrhea, ALRI and AURI. However, in children >18 months, TZ significantly reduced both the duration of diarrhea episodes and the incidence of future diarrhea episodes compared with placebo. Trial registration ClinicalTrials.gov: NCT02428647.
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Affiliation(s)
- Maxwell A Barffour
- Institute for Global Nutrition, University of California, Davis, California, USA.,College of Health and Human Services, Public Health Program, Missouri State University, Springfield, Missouri, USA
| | - Guy-Marino Hinnouho
- Institute for Global Nutrition, University of California, Davis, California, USA
| | - K Ryan Wessells
- Institute for Global Nutrition, University of California, Davis, California, USA
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic
| | - Kethmany Ratsavong
- Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic
| | - Dalaphone Sitthideth
- Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic
| | - Bangone Bounheuang
- Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic
| | - Khanpaseuth Sengnam
- Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic
| | - Bigphone Chanhthavong
- Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic
| | - Charles D Arnold
- Institute for Global Nutrition, University of California, Davis, California, USA
| | - Kenneth H Brown
- Institute for Global Nutrition, University of California, Davis, California, USA
| | - Charles P Larson
- School of Population and Global Health, McGill University, Montreal, Canada
| | - Sonja Y Hess
- Institute for Global Nutrition, University of California, Davis, California, USA
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Wessells KR, Brown KH, Arnold CD, Barffour MA, Hinnouho GM, Killilea DW, Kounnavong S, Hess SY. Plasma and Nail Zinc Concentrations, But Not Hair Zinc, Respond Positively to Two Different Forms of Preventive Zinc Supplementation in Young Laotian Children: a Randomized Controlled Trial. Biol Trace Elem Res 2021; 199:442-452. [PMID: 32356207 PMCID: PMC7746564 DOI: 10.1007/s12011-020-02163-2] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/15/2020] [Indexed: 11/29/2022]
Abstract
Plasma zinc concentrations (PZC) have been shown to significantly increase during zinc supplementation. This study investigated the effects of daily preventive zinc supplementation on hair and nail zinc concentrations compared with a control group. In a randomized controlled trial, 6- to 23-month-old children (n = 3407) in Lao PDR were randomly assigned to one of four groups and followed for ~ 36 weeks: daily preventive zinc dispersible tablet (7 mg/d; PZ), daily micronutrient powder (10 mg zinc/d; MNP), therapeutic zinc supplements for diarrhea treatment (20 mg/d for 10 days; TZ), or daily placebo powder (Control). Plasma, hair, and nail zinc concentrations were assessed in a sub-sample of participants (n = 457) at baseline and endline. At baseline, 75% of children had low PZC (< 65 μg/dL). At endline, geometric mean (95% CI) PZC were greater in the PZ and MNP groups compared with the TZ and control groups (P < 0.01), but hair zinc concentrations did not differ among groups (P = 0.99). Nail zinc concentrations were marginally higher in the PZ (115.8 (111.6, 119.9) μg/g) and the MNP (117.8 (113.3, 122.3) μg/g) groups than in the TZ group (110.4 (106.0, 114.8) μg/g; P = 0.055) at endline. This study does not support the use of hair zinc as a biomarker of zinc exposure in young children. However, it provides some evidence that zinc concentrations in nails may respond to supplemental zinc interventions and supports the need for collecting additional data on this emerging biomarker.
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Affiliation(s)
- K. Ryan Wessells
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, One Shields Ave, Davis, CA 95616 USA
| | - Kenneth H. Brown
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, One Shields Ave, Davis, CA 95616 USA
| | - Charles D. Arnold
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, One Shields Ave, Davis, CA 95616 USA
| | - Maxwell A. Barffour
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, One Shields Ave, Davis, CA 95616 USA
- McQueary College of Health and Human Services, Public Health Program, Missouri State University, 606E Cherry St, Springfield, MO 65897 USA
| | - Guy-Marino Hinnouho
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, One Shields Ave, Davis, CA 95616 USA
| | - David W. Killilea
- Children’s Hospital of Oakland Research Institute, 5700 Martin Luther King Jr Way, Oakland, CA 94609 USA
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ban Kaognot, Sisattanak District, Vientiane, Lao People’s Democratic Republic
| | - Sonja Y. Hess
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, One Shields Ave, Davis, CA 95616 USA
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Noguchi Y, Nonaka D, Kounnavong S, Kobayashi J. Effects of Hand-Washing Facilities with Water and Soap on Diarrhea Incidence among Children under Five Years in Lao People's Democratic Republic: A Cross-Sectional Study. Int J Environ Res Public Health 2021; 18:ijerph18020687. [PMID: 33466953 PMCID: PMC7829977 DOI: 10.3390/ijerph18020687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 01/16/2023]
Abstract
Diarrhea is a leading cause of death among children under five (U5) in Lao People’s Democratic Republic (PDR). This study assessed the association between the presence of household hand-washing facilities with water and soap and diarrhea episodes among children U5 in Lao PDR. Data from the Lao Social Indicator Survey II were used. The outcome variable was diarrhea episodes in the two weeks preceding the survey. The main predictor variable was the presence of household hand-washing facilities with or without water and/or soap. Mixed-effect logistic regression analysis was used to assess the association, controlling for clustering, and other predictor variables. Of the 8640 households surveyed with 11,404 children, 49.1% possessed hand-washing facilities with both water and soap and 34.7% possessed hand-washing facilities with water alone. Children whose households possessed hand-washing facilities with water alone were significantly more likely to have a diarrhea episode compared to children whose households possessed hand-washing facilities with both water and soap (8.1% vs. 5.9%; odds ratio, 1.49; 95% confidence interval, 1.22–1.81). The association remained significant even after adjusting for other predictors. The absence of soap in hand-washing facilities was associated with higher odds of having a diarrhea episode among children U5 in Lao PDR.
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Affiliation(s)
- Yuko Noguchi
- Graduate School of Health Sciences, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0125, Japan; (Y.N.); (J.K.)
| | - Daisuke Nonaka
- Graduate School of Health Sciences, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0125, Japan; (Y.N.); (J.K.)
- Correspondence: ; Tel.: +81-98-895-1666
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Samsenthai Road, Ban Kaognot, Sisattanack District, Vientiane 01030, Laos;
| | - Jun Kobayashi
- Graduate School of Health Sciences, University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0125, Japan; (Y.N.); (J.K.)
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Sengchaleun V, Samri MA, Kounnavong S, Reinharz D. Advocacy Coalition by External Actors and Strategies Used to Influence the Emergence of the National Nutrition Policy in Lao PDR. Health (London) 2021. [DOI: 10.4236/health.2021.138062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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