Impact evaluation of a cash-plus programme for children with disabilities in the Xiengkhouang Province in Lao PDR: study protocol for a non-randomised controlled trial

INTRODUCTION

More than 170 countries have implemented disability-targeted social protection programmes, although few have been rigorously evaluated. Consequently, a non-randomised controlled trial is being conducted of a pilot 'cash-plus' programme implemented by UNICEF Laos and the Laos government for children with disabilities in the Xiengkhouang Province in Laos. The intervention combines a regular cash transfer with provision of assistive devices and access for caregivers to a family support programme.

METHODS AND ANALYSIS

The non-randomised controlled trial will involve 350 children with disabilities across 3 districts identified by programme implementers as eligible for the programme (intervention arm). Implementers have also identified approximately 180 children with disabilities in neighbouring districts, who would otherwise meet eligibility criteria but do not live in the project areas (control arm). The trial will assess the impact of the programme on child well-being (primary outcome), as well as household poverty, caregiver quality of life and time use (secondary outcomes). Baseline data are being collected May-October 2023, with endline 24 months later. Analysis will be intention to treat. A complementary process evaluation will explore the implementation, acceptability of the programme, challenges and enablers to its delivery and mechanisms of impact.

ETHICS AND DISSEMINATION

The study has received ethical approval from the London School of Hygiene and Tropical Medicine and the National Ethics Committee for Health Research in Laos. Informed consent and assent will be taken by trained data collectors. Data will be collected and stored on a secure, encrypted server and its use will follow a detailed data management plan. Findings will be disseminated in academic journals and in short briefs for policy and programmatic actors, and in online and in-person events.

TRIAL REGISTRATION NUMBER

ISRCTN80603476.

Social Transfers for Exclusive Breastfeeding (STEB) Intervention in Lao People's Democratic Republic: Protocol for a Randomized Controlled Trial

BACKGROUND

Children in Lao People's Democratic Republic (Lao PDR) receive suboptimal nutrition because of low breastfeeding rates, undermining their developmental potential. While major public health campaigns have attempted to increase breastfeeding rates, they have been largely unsuccessful. One explanation for these unsuccessful interventions is the economic and financial constraints faced by mothers. A potential solution for alleviating these pressures is providing social transfers to support breastfeeding; defined as a cash or in-kind transfer. Capitalizing on key strategies used in previous social transfer programs, we will assess the effectiveness of social transfer intervention for increasing exclusive breastfeeding rates in Vientiane, Lao PDR.

OBJECTIVE

This study aims to conduct a randomized controlled trial (RCT) designed to assess whether social transfers can increase exclusive breastfeeding rates in Vientiane Capital, Lao PDR.

METHODS

A prospective, parallel cluster-RCT was conducted among 300 mothers who recently gave birth and initiated breastfeeding. Enrolling 100 participants for each intervention arm provided us with 80% power to detect an increase in exclusive breastfeeding from the anticipated 21% in the control arm to 40% in either of the 2 intervention arms. Mother-infant dyads were enrolled at approximately 1 month post partum. Follow-up visits will occur at 6 months, 1 year, 2 years, and 3 years post partum; with the ambition to extend the follow-up period. Mother-infant dyads were enrolled between August 2022 and April 2023 with follow-up until 3 years post partum (2026). A local study team comprised of 2 nurses and 2 laboratory technicians is responsible for enrollment and follow-up of participants. Participants were randomly assigned to one of three groups during the baseline, 1-month visit: (1) control group, no social transfer; (2) intervention group 1, an unconditional social transfer at 6 months post partum; and (3) intervention group 2, a social transfer at 6 months post partum conditional upon mothers exclusively breastfeeding. All groups received educational materials supporting mothers to exclusively breastfeed. The primary end point will be exclusive breastfeeding at 6 months post partum. Secondary end points will include exclusive and complementary breastfeeding duration, childhood wasting and stunting, child growth, maternal and infant stress, predictors of early breastfeeding cessation, intestinal inflammation, anemia, maternal weight loss, maternal blood pressure, maternal anxiety, and GRIT personality score. Questionnaires and physical examinations were used to collect information.

RESULTS

As of November 2023, the study has enrolled 300 participants. Study participation is ongoing until December 2026 at minimum. Over the study lifetime, 93% have completed all visits.

CONCLUSIONS

We see potential for a long-term program that may be implemented in other low- or lower-middle-income countries with only minor modifications. The RCT will be used as a basis for observational studies and to investigate the impact of human milk on child fecal microbiota and growth.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05665049; https://clinicaltrials.gov/study/NCT05665049.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/54768.

Spatial clusters of human and livestock anthrax define high-risk areas requiring intervention in Lao Cai Province, Vietnam 1991-2022

Anthrax, a widespread zoonosis in low and middle-income countries with low disease awareness and insufficient livestock vaccination coverage, has been known in Lao Cai Province in northern Vietnam for years before its apparent absence in 2009, which requires investigation as this infection is frequently reported from neighbouring provinces and countries. We aimed to describe the seasonal patterns of anthrax (1991-2008), compare livestock anthrax vaccine coverage to disease occurrence (1991- 2022), and delineate the high-risk areas to inform local disease surveillance in the province. We illustrated the seasonal pattern of anthrax and provided a comparison between livestock vaccine coverage and disease occurrence by purely spatial SaTScan (Poisson model, 25% population at risk) to detect spatial clusters of human and livestock anthrax using population derived from zonal statistics routines. The number of cases, crude cumulative incidence, and spatial clusters of human and livestock anthrax were mapped in QGIS. Results indicate peak anthrax incidence from May to October. Buffalo, domestic cattle, and horses accounted for 75% of total animal cases. Horse anthrax was more common in Lao Cai than in its neighbours and often occurred in years with human mortality. Vaccination covered less than 30% of the livestock population. We found an apparent pattern where anthrax was controlled from 1998-2003 with higher vaccine coverage (>20%) and identified spatial clusters of human and livestock anthrax in Muong Khuong, Bao Thang, and Bac Ha districts of Lao Cai. The local public health and veterinary agencies are recommended to revisit the high-risk areas and communicate with neighbouring provinces for a regional approach to anthrax surveillance and control.

Diagnostic accuracy of DPP Fever Panel II Asia tests for tropical fever diagnosis

BACKGROUND

Fever is the most frequent symptom in patients seeking care in South and Southeast Asia. The introduction of rapid diagnostic tests (RDTs) for malaria continues to drive patient management and care. Malaria-negative cases are commonly treated with antibiotics without confirmation of bacteraemia. Conventional laboratory tests for differential diagnosis require skilled staff and appropriate access to healthcare facilities. In addition, introducing single-disease RDTs instead of conventional laboratory tests remains costly. To overcome some of the delivery challenges of multiple separate tests, a multiplexed RDT with the capacity to diagnose a diverse range of tropical fevers would be a cost-effective solution. In this study, a multiplex lateral flow immunoassay (DPP Fever Panel II Assay) that can detect serum immunoglobulin M (IgM) and specific microbial antigens of common fever agents in Asia (Orientia tsutsugamushi, Rickettsia typhi, Leptospira spp., Burkholderia pseudomallei, Dengue virus, Chikungunya virus, and Zika virus), was evaluated.

METHODOLOGY/PRINCIPAL FINDINGS

Whole blood (WB) and serum samples from 300 patients with undefined febrile illness (UFI) recruited in Vientiane, Laos PDR were tested using the DPP Fever Panel II, which consists of an Antibody panel and Antigen panel. To compare reader performance, results were recorded using two DPP readers, DPP Micro Reader (Micro Reader 1) and DPP Micro Reader Next Generation (Micro Reader 2). WB and serum samples were run on the same fever panel and read on both micro readers in order to compare results. ROC analysis and equal variance analysis were performed to inform the diagnostic validity of the test compared against the respective reference standards of each fever agent (S1 Table). Overall better AUC values were observed in whole blood results. No significant difference in AUC performance was observed when comparing whole blood and serum sample testing, except for when testing for R. typhi IgM (p = 0.04), Leptospira IgM (p = 0.02), and Dengue IgG (p = 0.03). Linear regression depicted R2 values had ~70% agreement across WB and serum samples, except when testing for leptospirosis and Zika, where the R2 values were 0.37 and 0.47, respectively. No significant difference was observed between the performance of Micro Reader 1 and Micro Reader 2, except when testing for the following pathogens: Zika IgM, Zika IgG, and B pseudomallei CPS Ag.

CONCLUSIONS/SIGNIFICANCE

These results demonstrate that the diagnostic accuracy of the DPP Fever Panel II is comparable to that of commonly used RDTs. The optimal cut-off would depend on the use of the test and the desired sensitivity and specificity. Further studies are required to authenticate the use of these cut-offs in other endemic regions. This multiplex RDT offers diagnostic benefits in areas with limited access to healthcare and has the potential to improve field testing capacities. This could improve tropical fever management and reduce the public health burden in endemic low-resource areas.

Development of a patient satisfaction questionnaire (PSQ) for diabetes management in Thailand and Lao PDR

In a cross-sectional analytical study, a Patient Satisfaction Questionnaire (PSQ) for diabetes management was developed and tested in Thailand and Lao PDR. A systematic review of qualitative studies was conducted to formulate themes of the PSQ. The 20-item PSQ was prepared in Thai and translated to Lao, with subsequent backward translation. Both versions were tested for reliability and construct validity using confirmatory factor analysis and structural equation modeling. The study was performed at a university hospital in Thailand and two central hospitals in Vientiane, Lao PDR. There were 300 diabetic patients from Thailand (n = 150) and Lao PDR (n = 150). The 5-factor Thai version showed 74.52% of total explained variance with good internal consistency and satisfactory goodness-of-fit indices (χ2/df = 1.91, GFI = 0.83, CFI = 0.98, SRMR = 0.063, RMSEA = 0.078). The five factors were 1) Standard of Service, 2) Diabetic Service, 3) Competency of Providers, 4) Competency of Pharmacists, and 5) Communication with Providers. For the Lao version, 20 items showed a 3-factor structure with a total explained variance of 71.09%. Goodness-of-fit indices for the Lao model were satisfactory (χ2/df = 2.45, GFI = 0.78, CFI = 0.95, SRMR = 0.075 and RMSEA = 0.095). The results showed the PSQ Thai and Lao versions were valid and reliable for assessing patient satisfaction with diabetes management, however more testing of the questionnaire is appropriate.

Efficacy and safety of moxidectin compared with ivermectin against Strongyloides stercoralis infection in adults in Laos and Cambodia: a randomised, double-blind, non-inferiority, phase 2b/3 trial

BACKGROUND

Infection with the soil-transmitted helminth Strongyloides stercoralis affects up to 600 million people globally, most of whom live in rural areas with poor sanitation. If untreated, infection leads to long-lasting morbidity and might even be life-threatening. Moxidectin might be a promising alternative to ivermectin, the only currently recommended single-dose treatment. We aimed to assess whether moxidectin is non-inferior in terms of efficacy and safety compared with ivermectin.

METHODS

In this randomised, double-blind, parallel-group, non-inferiority, phase 2b/3 trial in communities in Laos and Cambodia, adults aged 18-65 years were screened for the presence of S stercoralis larvae in their stool via sextuplicate quantitative Baermann assays. Using computer-generated group allocation (block randomisation stratified by infection intensity), parasitologically (two or more positive Baermann assays) and clinically eligible participants were randomly assigned (1:1) to receive single oral doses of either moxidectin (8 mg) and ivermectin-matched placebo, or ivermectin (200 μg/kg bodyweight) and moxidectin-matched placebo. The primary endpoint was cure rate assessed at 14-21 days after treatment, using the available-case population analysed according to intention-to-treat principles. Moxidectin was considered non-inferior to ivermectin if the lower limit of the two-sided 95% CI of the difference was greater than the non-inferiority margin of -10 percentage points. Safety endpoints were assessed before treatment, and at 2-3 h, 24 h, and 14-21 days after treatment. This trial is registered at ClinicalTrials.gov, NCT04056325 and NCT04848688.

FINDINGS

Between Dec 6, 2020, and May 21, 2022, 4291 participants were screened, 726 of whom were enrolled and randomly assigned to moxidectin (n=363) or ivermectin (n=363). For the participants with primary outcome data, we observed a cure rate of 93·6% (95% CI 90·5 to 96·0; 324 of 346 participants) in the moxidectin group and 95·7% (93·0 to 97·6; 335 of 350 participants) in the ivermectin group, resulting in a between-group difference of -2·1 percentage points (95% CI -5·5 to 1·3). The most common adverse events were abdominal pain (32 [9%] of 363 with moxidectin vs 34 [9%] of 363 with ivermectin) and headache (25 [7%] vs 30 [8%]), which were predominantly mild and transient.

INTERPRETATION

Moxidectin was non-inferior to ivermectin in terms of efficacy in the treatment of strongyloidiasis. Additionally, both drugs had a similar safety profile. The fixed dose and lower cost of moxidectin compared with ivermectin make it a valuable alternative for people with strongyloidiasis.

FUNDING

Swiss National Science Foundation.

Sustaining essential health services in Lao PDR in the context of donor transition and COVID-19

Lao People's Democratic Republic (Lao PDR) aims at graduating from least developed country status by 2026 and must increase the level of domestic financing for health. This paper examines how the government has prepared for the decline of external assistance and how donors have applied their transition approaches. Adapting a World Health Organization (WHO) framework, reflections and lessons were generated based on literature review, informal and formal consultations and focus group discussions with the Lao PDR government and development partners including budget impact discussion. The government has taken three approaches to transition from external to domestic funding: mobilizing domestic resources, increasing efficiency across programs and prioritization with a focus on strengthening primary health care (PHC). The government has increased gradually domestic government health expenditures as a share of the government expenditure from 2.6% in 2013 to 4.9% in 2019. The Ministry of Health has made efforts to design and roll out integrated service delivery of maternal, newborn, child, and adolescent health services, immunization and nutrition; integrated 13 information systems of key health programs into one single District Health Information Software 2; and prioritized PHC, which has led to shifting donors towards supporting PHC. Donors have revisited their aid policies designed to improve sustainability and ownership of the government. However, the government faces challenges in improving cross-programmatic efficiency at the operational level and in further increasing the health budget due to the economic crisis aggravated during Coronavirus disease 2019 (COVID-19). Working to implement donor transition strategies under the current economic situation and country challenges, calls into question the criteria used to evaluate transition. This criterion needs to include more appropriate indicators other than gross national income per capita, which does not reflect a country's readiness and capacity of the health system. There should be a more country-tailored strategy and support for considering the context and system-wide readiness during donor transition.

Prospects for the development of community-based care in remote rural areas: a stakeholder analysis in Laos

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.

Program evaluation of postgraduate obstetrics and gynecology training in Lao people's democratic republic - using the CIPP model

BACKGROUND

The obstetrics and gynaecology (OB-GYN) residency training program in Lao People's Democratic Republic (PDR) began in 2003 based on the Millennium Development Goals (MDGs) and 'Reproductive, maternal, newborn, and child health interventions (RMNCH) strategies and action plan'. However, the training program had not been properly evaluated previously. The purpose of this study is to evaluate the current postgraduate OB-GYN residency training program in Lao PDR by using CIPP model to identify the current problems (the strengths and weaknesses) and suggest a future plan to promote continuous improvement.

METHOD

The context, input, process, and product classification (CIPP) model was used to develop criteria and indicators. A mixed-methods approach was used for this study. To capture instructional material for quantitative analysis, a Google survey with 38 items and a t-test were used to determine a significant difference in responses between residents and lecturers (N = 120). Based on qualitative analysis, an in-depth interview was done (four questions based on study outcomes, including satisfaction, strengths and weaknesses, and future opportunities), and six interviews provided different viewpoints on the course. The SPSS software program was used to measure validity, with p-values = 0.05.

RESULTS

The overall average response rate was 97.5%. Two significant differences in program perspectives were revealed between lecturers and residents, difficulties in maintaining the course (professors 3.66 ± 1.03 and residents 3.27 ± 0.98, p = 0.04) and learning outcomes achieved (professors 3.57 ± 0.85 and residents 3.14 ± 0.95, p = 0.01 The overall average for the context part of the questionnaire was under 3.00, with the lowest scores for overlapped learning outcomes and difficulties in maintaining the course. The input part, lack of the classroom, skills lab and staff; the process part, lecturer to collect student opinions and the product part on learning outcomes.

CONCLUSION

Curriculum improvement based on the program evaluation results, including regular evaluation and feedback, will advance the residency training program based on the RMNCH strategy and contribute to the promotion of maternal health in the Lao PDR.

Transition to a market economy and chronic psychosocial stress in northern Laos: An exploratory study of urinary free cortisol in rural residents

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.

Review of the genus Diduga (Lepidoptera, Erebidae, Arctiinae) of Laos, with description of one new species

The genus Diduga Moore, [1887] is reviewed with 11 species from Laos, including one new species, D. bantha sp. nov. Illustrations of adults and genitalia of all examined species from Laos are provided, with the checklist of Laotian species of the genus Diduga.

Laos' Social Health Insurance (SHI) program's impact on older people's accessibility and financial security against catastrophic health expense

Laos has introduced various SHI schemes for multiple groups of the population, such as government officials and other population groups under the NHI schemes. There is no specific health insurance policy for this group of people who need special health services and may have a higher possibility of entering financial catastrophe. This study aims to assess the impact of SHI schemes on accessibility and financial catastrophe against catastrophic health expenditures for older people in Laos. A structured questionnaire has been used to retrieve information from 400 older people across 39 villages in Kaysone Phomvihane District, Savannakhet province, the largest province in Laos. In the analytical process, this study used a cross-sectional study design and binary logistic regression models to predict the likelihood of accessing health facilities and experiencing financial catastrophe. The study outcome shows that the increase in age, occupation, number of older people within a household, and presence of chronic conditions increase the likelihood of using health services. Despite the existence of various SHI schemes, this study found that 74 out of 165 households reported using health services experienced catastrophic health expenditure. Several characteristics are associated with catastrophic health expenditure: age, income level, and gender are prone to suffer from catastrophic health expenditure. The difficult problems stem from the absence of comprehensive legislation regarding the older population. Recommendations for policymakers in various timeframes have been made, which cover short- and long-term policy proposals, including providing a specialized lane or fast-track for an older population, building health facilities exclusively for older people, and providing transportation services for older individuals living alone.

Hiding on jagged karst pinnacles: A new microendemic genus and species of a limestone-dwelling agamid lizard (Squamata: Agamidae: Draconinae) from Khammouan Province, Laos

We describe a unique new species and genus of agamid lizard from the karstic massifs of Khammouan Province, central Laos. Laodracon carsticola Gen. et sp. nov. is an elusive medium-sized lizard (maximum snout-vent length 101 mm) specifically adapted to life on limestone rocks and pinnacles. To assess the phylogenetic position of the new genus amongst other agamids, we generated DNA sequences from two mitochondrial gene fragments (16S rRNA and ND2) and three nuclear loci ( BDNF, RAG1 and c-mos), with a final alignment comprising 7 418 base pairs for 64 agamid species. Phylogenetic analyses unambiguously place the new genus in the mainland Asia subfamily Draconinae, where it forms a clade sister to the genus Diploderma from East Asia and the northern part of Southeast Asia. Morphologically, the new genus is distinguished from all other genera in Draconinae by possessing a notably swollen tail base with enlarged scales on its dorsal and ventral surfaces. Our work provides further evidence that limestone regions of Indochina represent unique "arks of biodiversity" and harbor numerous relict lineages. To date, Laodracon carsticola Gen. et sp. nov. is known from only two adult male specimens and its distribution seems to be restricted to a narrow limestone massif on the border of Khammouan and Bolikhamxai provinces of Laos. Additional studies are required to understand its life history, distribution, and conservation status.

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

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.

Palaeoenvironments and hominin evolutionary dynamics in southeast Asia

Secure environmental contexts are crucial for hominin interpretation and comparison. The discovery of a Denisovan individual and associated fauna at Tam Ngu Hao 2 (Cobra) Cave, Laos, dating back to 164-131 ka, allows for environmental comparisons between this (sub)tropical site and the Palearctic Denisovan sites of Denisova Cave (Russia) and Baishiya Karst Cave (China). Denisovans from northern latitudes foraged in a mix of forested and open landscapes, including tundra and steppe. Using stable isotope values from the Cobra Cave assemblage, we demonstrate that, despite the presence of nearby canopy forests, the Denisovan individual from Cobra Cave primarily consumed plants and/or animals from open forests and savannah. Using faunal evidence and proxy indicators of climates, results herein highlight a local expansion of rainforest at ~ 130 ka, raising questions about how Denisovans responded to this local climate change. Comparing the diet and habitat of the archaic hominin from Cobra Cave with those of early Homo sapiens from Tam Pà Ling Cave (46-43 ka), Laos, it appears that only our species was able to exploit rainforest resources.

Short-Term Acceptability of Ready-to-Use Therapeutic Foods in Two Provinces of Lao People's Democratic Republic

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.

Thermodynamic and kinetic analysis of the LAO binding protein and its isolated domains reveal non-additivity in stability, folding and function

Substrate-binding proteins (SBPs) are used by organisms from the three domains of life for transport and signalling. SBPs are composed of two domains that collectively trap ligands with high affinity and selectivity. To explore the role of the domains and the integrity of the hinge region between them in the function and conformation of SBPs, here, we describe the ligand binding, conformational stability and folding kinetics of the Lysine Arginine Ornithine (LAO) binding protein from Salmonella thiphimurium and constructs corresponding to its two independent domains. LAO is a class II SBP formed by a continuous and a discontinuous domain. Contrary to the expected behaviour based on their connectivity, the discontinuous domain shows a stable native-like structure that binds l-arginine with moderate affinity, whereas the continuous domain is barely stable and shows no detectable ligand binding. Regarding folding kinetics, studies of the entire protein revealed the presence of at least two intermediates. While the unfolding and refolding of the continuous domain exhibited only a single intermediate and simpler and faster kinetics than LAO, the folding mechanism of the discontinuous domain was complex and involved multiple intermediates. These findings suggest that in the complete protein the continuous domain nucleates folding and that its presence funnels the folding of the discontinuous domain avoiding nonproductive interactions. The strong dependence of the function, stability and folding pathway of the lobes on their covalent association is most likely the result of the coevolution of both domains as a single unit.

The Concepts of Women's Empowerment in Child Malnutrition Programs in Luangprabang Province, Lao People's Democratic Republic

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.

Taxonomic review of the Cyana adelina (Staudinger) species-group (Lepidoptera: Erebidae: Arctiinae) with descriptions of three new species and one new subspecies from Laos, Thailand and China

The Cyana adelina (Staudinger, 1887) species-group is established and reviewed. Three new species and one new subspecies are described: Cyana yunnanensis regia ssp. n. (Northern Thailand and northern Laos), Cyana dubernardi sp. n. (China: Yunnan), Cyana khami sp. n. (central Laos), and Cyana karsticola sp. n. (northern Laos). Two new synonyms are established: Cyana yunnanensis yunnanensis (Hampson, 1903) (Chionaema) = Chionaema hoenei Daniel, 1952, syn. n., and Cyana griseilinea de Joannis, 1930 = Cyana succincta ern, 2016, syn. n. Lectotypes are designated for Bizone adelina Staudinger, 1887 and Bizone pratti Elwes, 1890. Adults, male and female genitalia are illustrated.

Assessing SDG-3 efficiency for SDG-1 by studying interplay of tourism development, poverty alleviation and sustainability

The modern world is facing chaos of different connected issues. Achieving sustainability in the tourism industry for poverty reduction is one of them, having limited guidance for stakeholders. Thus, following SDG-3 guidelines for good well-being via tourism development could contribute to SDG-1 for no poverty. This roadmap needs scientific validation. Therefore, this research aims to determine how much of an overall impact tourism has on alleviating poverty and what factors account for the wide range of estimates of that impact. Using data from 2002 to 2020 and the ARDL model with eight variables, including (a) currency supply, (b) GDP per capita, and (c) tourism earnings higher GDP area, the current emphasis is on reducing the likelihood of any negative impacts this business may have on tourism. Lower Gross Domestic Product (GDP) regions, higher profits per capita from tourism, and reduced poverty all have a role. With a 1% significance threshold, the observed data becomes more convincing. Last, the results show that the Laotian government intends for tourism to contribute to long-term environmentally responsible financial development. In addition, the study's empirical results corroborated the conclusion that policymakers should encourage the successful expansion of the tourist industry.

Long-term monitoring of forest cover change resulting in forest loss in the capital of Luang Prabang province, Lao PDR

Loss of forest cover has an important impact on global climate change. This study investigated variation in forest cover in Luang Prabang district, the capital of Luang Prabang province, Lao PDR, using Landsat Thematic Mapper (TM) and Operational Land Imager (OLI) satellite imagery over the period 1988-2021. The maximum likelihood classification technique was used to classify Landsat images of the years 1988, 2001, 2011, and 2021 and was evaluated for accuracy using the kappa coefficient for each year (0.860, 0.869, 0.878, and 0.950, respectively). The potential of classification based on the Normalized Difference Vegetation Index (NDVI) and Soil Adjusted Vegetation Index (SAVI) to detect changes in natural forest and cultivated forest cover compared with supervised classification was also evaluated. The natural forest cover of the study area was estimated at 84.09% (687.82 km2) of the total land area in 1988. This number decreased to 56.93% (465.69 km2) in 2001 and subsequently increased to 60.85% (497.77 km2) in 2011 and 66.49% (543.92 km2) in 2021. Cultivated forest cover in 1988 was 4.96% (40.58 km2) and increased to 16.84% (137.76 km2) in 2001, however it decreased to 13.57% (110.97 km2) in 2011 and 9.67% (79.10 km2) in 2021. Severely reduced forest cover is often associated with the expansion of agriculture on the forest edge. Logging and charcoal production are other problems that contribute to the reduction of forest cover. Overall, our results show the necessity of forest management, rational land-use planning policy, and increased community awareness of conservation and sustainable development of forest resources in the study area in the future.

The highly diverse plasmid population found in Escherichia coli colonizing travellers to Laos and its role in antimicrobial resistance gene carriage

Increased colonization by antimicrobial-resistant organisms is closely associated with international travel. This study investigated the diversity of mobile genetic elements involved with antimicrobial resistance (AMR) gene carriage in extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli that colonized travellers to Laos. Long-read sequencing was used to reconstruct complete plasmid sequences from 48 isolates obtained from the daily stool samples of 23 travellers over a 3 week period. This method revealed a collection of 105 distinct plasmids, 38.1 % (n=40) of which carried AMR genes. The plasmids in this population were diverse, mostly unreported and included 38 replicon types, with F-type plasmids (n=23) the most prevalent amongst those carrying AMR genes. Fine-scale analysis of all plasmids identified numerous AMR gene contexts and emphasized the importance of IS elements, specifically members of the IS6/IS26 family, in the evolution of complex multidrug resistance regions. We found a concerning convergence of ESBL and colistin resistance determinants, with three plasmids from two different F-type lineages carrying bla CTX-M and mcr genes. The extensive diversity seen here highlights the worrying probability that stable new vehicles for AMR will evolve in E. coli populations that can disseminate internationally through travel networks.

Determinants of oxidative stress among indigenous populations in Northern Laos: Trace element exposures and dietary patterns

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.

Integrated assessment of climate change and reservoir operation on flow-regime and fisheries of the Sekong river basin in Lao PDR and Cambodia

This study assesses the cumulative impact of climate change and reservoir operation on flow regime and fisheries in the Sekong River Basin. Ensemble of five selected Regional Climate Models (RCMs) were used to project the future climate under RCP4.5 and RCP8.5 scenarios. The projected future climate was used to simulate the future hydrology using the SWAT model while HEC-ResSim was utilized for reservoir simulation. Finally fish-flow relationship was developed to estimate the fish catch and productivity in future. Upon investigation we found that, Sekong River Basin is likely grow warmer and drier in future under climate change. The basin is expected to face 1.3-3.6 °C rise in mean annual temperature and receive 0-6% less annual rainfall in future. The wet season in the basin is anticipated to be drier (0% to -6%) while the dry season rainfall shows no particular trend (-3%-10%). Such a change in climate is likely to alter the mean annual flow in future between -3 and 5% at Attapeu, -6 to 2% at Ban Veunkhane, Lao PDR, and -7 to 1% at Siempang, Cambodia (basin outlet). Under climate change, we expect decrement in minimum flow but increment in the maximum flow while opposite is anticipated under reservoir operation. Operation of Xekaman 1 and Sekong 4A are likely to increase the minimum flow at river outlet by 32-59% and 13-18% respectively whereas maximum flow is expected to decrease by 28-5%. In addition, climate change is likely to have crucial impact on fisheries with up to 19% and 12% reduction in fish catches and fish productivity respectively. However, reservoirs tend to have negligible impact on fisheries.

Fe12LaO19 fabricated biochar for removal of phosphorus in water and exploration of its adsorption mechanism

Phosphorus (P) runoff from untreated wastewater and agricultural runoff has become an issue of concern because excessive P is detrimental to the health of water bodies and aquatic organisms such as fishes. Hence, different methods are being developed to salvage this challenge. However, most of the methods are expensive, while some are unsustainable. In this study, a simple method was employed in fabricating an absorbent through the co-precipitation of iron and lanthanum on the matrix of biochar prepared from the spent coffee ground for P uptake. The adsorbent named Fe₁₂LaO₁₉@BC was able to attain equilibrium fast within 60 min when used to adsorb P with 98% P removal within the first 30 min Fe₁₂LaO₁₉@BC also maintained high P adsorption across a pH range of 3-7. In the presence of other anions (SO₄^2-, CO₃^2-, NO₃^-, Cl^-, HCO₃^-) in the solution, Fe₁₂LaO₁₉@BC enabled 71.5-97.8% uptake of P. 81.58 mg P/g maximum adsorption capacity at was reached at 40 °C. The reusability test reveals that about 60% of P uptake was maintained after five adsorption cycles with almost an undisturbed desorption efficiency. The negative value of ΔG°, as shown by the thermodynamic analysis, indicates a favorable and spontaneous reaction during P removal by Fe₁₂LaO₁₉@BC. The XRD analysis showed a major peak corresponding to Fe₁₂LaO_19, which is believed to have facilitated the adsorption of P. The adsorption was controlled by multiple mechanisms. An overview of the study indicates Fe₁₂LaO₁₉@BC as a promising adsorbent for the removal of P in the water.

Source appointment and health risk assessment of polycyclic aromatic hydrocarbons in paddy grain from Thailand and Laos

Rice is a staple meal for the majority of Asians. However, human exposure to polycyclic aromatic hydrocarbons from paddy grain is largely unknown in Thailand and Laos. Therefore, information on the quantitative measurement and assessment of the health problems caused by PAHs was analyzed. The results showed that the concentrations of total PAHs in paddy grain in Thailand and Laos were 38.86 ± 5.13 and 11.35 ± 1.96 ng g^-1, respectively. The highest concentration of PAHs in Thailand was B[k]F, whereas D[a,h]A was found to be the highest in Laos. A p-value less than 0.05 was defined, which showed B[b]F and B[k]F from Thailand and Laos were significant, which indicated that they could be from a different pollutant source. The main finding of this study, which was supported by the diagnostic ratios of PAHs and HCA, was that the primary source of PAHs was assumed to be incomplete combustion of petroleum products, which was caused by the burning of industrial fuels or vehicle exhausts, as well as open burning. The findings suggest that these two nations have similar PAH origins. Agricultural waste burning and transportation emissions are well-known sources of PAHs in Thailand and Laos. The cancer risk assessment method was based on the accumulation of PAHs from paddy grains. An ILCR of 1.0E-06 to 1.0E-04 was considered a tolerable limit of cancer risk, while a risk > 1.0E-04 was considered a concern in terms of cancer risk. The findings indicated that while PAH emissions exist, their contribution to global toxicity may be anticipated to be low in inhalation exposure. The higher values of ingestion and dermal risk estimated were regarded as the tolerable limit of cancer risk in children and adults from both countries, indicating that cancer risk in both nations falls within the "acceptable level" range.

Financing Comprehensive Immunization Services in Lao PDR: A Fiscal Space Analysis From a Public Policy Perspective

INTRODUCTION

A comprehensive package of immunization services is an internal component of the Essential Health Service Package (ESP) implemented by Government of Lao People's Democratic Republic (Lao PDR). Thus, the cost of delivering the immunization program and its feasibility given the fiscal space emerges as an important policy question. The present analysis was undertaken to estimate the total cost of implementing the immunization program under ESP, determinants of total cost and the program's fiscal implications from the government's perspective.

METHODOLOGY

We employed a normative costing approach for costing of immunization services under ESP. Standard treatment guidelines (STGs) from both within and outside Lao PDR were considered to identify the resource use for each vaccine delivery. Subsequently, cost per dose administered and fully immunized beneficiary were computed. We assessed the fiscal space for financing immunization services in Lao PDR by adapting the decomposition method given by Tandon et al. RESULTS: In 2019, the estimated total cost of financing immunization in Lao PDR was US$12 million, which will increase in 2025 by 1.75 times, to US$21 million. The per capita budget for immunization needs to increase from about US$2 to US$7. Introduction of newer vaccines in the immunization schedule accounts for the major share (60%) of the increased cost for financing immunization. In view of current fiscal space, the government immunization expenditure (GIE) allocations will be adequate only in a scenario where no new vaccine is introduced under ESP in future years.

CONCLUSION

The current fiscal space would fall short of meeting the aspirational goals of ESP-Immunization for the introduction of newer vaccines in Lao PDR. The present analysis of the fiscal space provides important evidence to support a greater role for the Global Alliance for Vaccine Initiative (GAVI) to continue to finance immunization in Lao PDR. A publicly financed immunization model in Lao PDR would require significant strategic amendments with low short-term viability.

Detection of pyrethroid resistance mutations and intron variants in the voltage-gated sodium channel of Aedes (Stegomyia) aegypti and Aedes (Stegomyia) albopictus mosquitoes from Lao People's Democratic Republic

In Lao People's Democratic Republic, Aedes aegypti (Linnaeus 1762) and Aedes albopictus (Skuse 1894) mosquitoes (Diptera: Culicidae) are vectors of arboviral diseases such as dengue. As the treatment for these diseases is limited, control of the vectors with the use of pyrethroid insecticides is still essential. However, mutations in the voltage-gated sodium channel (vgsc) gene giving rise to pyrethroid resistance are threatening vector control programs. Here, we analysed both Ae. aegypti and Ae. albopictus mosquitoes, which were collected in different districts of Laos (Kaysone Phomvihane, Vangvieng, Saysettha and Xaythany), for vgsc mutations commonly found throughout Asia (S989P, V1016G and F1534C). Sequences of the vgsc gene showed that the F1534C mutation was prevalent in both Aedes species. S989P and V1016G mutations were detected in Ae. aegypti from each site and were always found together. In addition, the mutation T1520I was seen in Ae. albopictus mosquitoes from Saysettha district as well as in all Ae. aegypti samples. Thus, mutations in the vgsc gene of Ae. aegypti are prevalent in the four districts studied indicating growing insecticide resistance throughout Laos. Constant monitoring programmes and alternative strategies for controlling Aedes should be utilized in order to prolong the effectiveness of pyrethroids thereby maximizing vector control.

Needs assessment for faculty development in dental education, at the University of Health Sciences, Lao PDR

Due to the short history of dental education in Laos, the educational system is still incomplete, with only a few faculty development (FD) programs. This study aims to identify the needs assessment for FD, in Lao dental education. A survey was conducted, with dentists from the Faculty of Dentistry, in 2022. Data on demographics, perceived importance, and ability, on the 13 roles and competencies of teachers, as well as the 26 FD items' needs assessment were collected. Data were compared between the two groups (lecturers and assistant teachers), and analyzed to identify different needs. Sixty-seven responses were included, after excluding inappropriate ones. Lecturers and assistant teachers expressed their needs for developing a syllabus, and teaching using simulation. Lecturers revealed the need to improve their roles as resource developers, followed by learning facilitators and lecturer in a classroom setting. Assistant teachers reported their prioritized needs for improving their role as on-the-job role models, followed by lecturer in a classroom setting, and mentor, personal adviser, or tutor. Assistant teachers showed higher educational needs scores than lecturers, in most questionnaire items. Although the needs assessment of FD indicates different needs, based on the differing roles and responsibilities, assistant teachers' needs scores are generally higher. An FD program could prioritize the most common needs of both groups at an early stage, but the topics most needed by each group should also be considered. This study can inform a future FD program, to improve Lao dental education.

The Genus Haemaphysalis (Acari: Ixodidae) in Laos: An Update of Species Records and a Review of Taxonomic Challenges

Haemaphysalis Koch, 1844, is the largest genus of ticks in Southeast Asia, but little information is available concerning the species present in Laos. Recent research has yielded records for 10 Haemaphysalis species in Laos, including 5 new records, as well as 3 morphological entities of uncertain status. Further morphological and molecular studies are needed to clarify our taxonomic understanding of this genus in Southeast Asia.

Evaluating the Resources and Environmental Carrying Capacity in Laos Using a Three-Dimensional Tetrahedron Model

(1) Background: The quantitative evaluation and comprehensive measurement of resources and environmental carrying capacity (RECC) are key links in the study of RECC from classification to synthesis. Laos, as the only landlocked country of Mainland Southeast Asia (MSEA), is an important economic corridor (i.e., China-MSEA Economic Corridor) of the Belt and Road Initiative (BRI). (2) Methods: Based on the human settlements index (HSI), resource carrying index (RCI), and socio-economic development index (SDI), here, a three-dimensional tetrahedron model for the comprehensive assessment of RECC with equilibrium significance was constructed, including HSI-based suitability classification, RCI-based restrictive classification, and SDI-based adaptability classification. Taking provinces as the basic unit, we quantitatively assessed and comprehensively evaluated RECC in Laos using a three-dimensional tetrahedron model. (3) Results: The human settlement environment in Laos is mainly characterized by the moderate suitable category (85%), while the high suitability area (merely 5%) supports more than 30% of the total population. Laos had over 90% of its area in good condition in resources and environmental carrying status (surplus or balanced state), translating into more than 95% of the population. The social and economic development level is mainly characterized by low-level development (43%), with nearly 30% of the population living in these low-level areas. The comprehensive bearing state of resources and environment is characterized by surplus, and 85% of the population is distributed in the surplus area, which occupies 63% of the land. (4) Conclusions: It is possible to better explore the adaptation strategies and countermeasures for enhancing RECC in Laos and provide a scientific reference for regional sustainable development. We believe that the three-dimensional tetrahedron method can be applied to quantitatively evaluate and comprehensively measure RECC at larger scale, e.g., the BRI regions.

Fecal carriage and clonal dissemination of blaNDM-1 carrying Klebsiella pneumoniae sequence type 147 at an intensive care unit in Lao PDR

OBJECTIVES

Carbapenemase-producing Enterobacterales (CPE) are high priority targets of global antimicrobial surveillance. Herein, we determined the colonization rate of CPE on admission to intensive care units in Vientiane, Lao PDR in August-September 2019.

METHODS

Data regarding clinical conditions, infection control, and antibiotic usage were collected during admission. Rectal swab samples (n = 137) collected during admission were inoculated to selective chromogenic agars, followed by confirmatory tests for extended-spectrum beta-lactamases and carbapenemases. All CPE isolates were sequenced on Illumina (HiSeq2500), reads assembled using SPAdes 3.13, and the draft genomes used to query a database (https://www.genomicepidemiology.org) for resistome, plasmid replicons, and sequence types (ST). Optical DNA mapping (ODM) was used to characterize plasmids and to determine location of resistance genes. Minimum spanning tree was generated using the Bacterial Isolate Genome Sequence database (BIGSdb) and annotated using iTOL.

RESULT

From 47 Enterobacterales isolated on selective agars, K. pneumoniae (25/47) and E. coli (12/47) were the most prevalent species, followed by K aerogenes (2/47), K. variicola (1/47), and K. oxytoca (1/47). The overall prevalence of ESBLs was 51.0%; E. coli 83.3% (10/12) and Klebsiella spp. 41.3% (12/29). Twenty percent of the K. pneumoniae (5/25) isolates were carbapenem-resistant, and 4/5 contained the blaNDM-1 gene. All blaNDM-1 isolates belonged to ST147 and were indistinguishable with cgMLST. ODM showed that the blaNDM-1 gene was located on identical plasmids in all isolates.

CONCLUSION

The prevalence of ESBL-producing Enterobacterales was high, while carbapenemases were less common. However, the detection of clonal dissemination of blaNDM-1-producing K. pneumoniae isolates in one of the intensive care units calls for vigilance. Stringent infection prevention and antimicrobial stewardship strategies are highly important measures.

Lifestyles, sexuality and gender: vulnerability to STIs and unplanned pregnancy among female migrant beer promoters in Lao PDR

In Southeast Asia, many young rural female migrants supplement their income by working as beer promoters. This study examined how young, female beer promoters working in Vientiane Capital, Lao PDR, navigate intimate relations and sexual encounters and how their experiences create sexual vulnerabilities. A total of 30 female beer promoters aged 18-24 years old were recruited using snowball sampling. Repeated face-to-face in-depth interviews were undertaken and thematic analysis conducted to identify common themes. Most participants had their first coital experience pre-migration but living in the city introduced them to a larger pool of potential partners. Unprotected sexual intercourse was common, with young women usually deferring to their male partners preference for non-condom use. Working as beer promoters, the sexualised environment of the bar room promoted male ideals of femininity and exposed the young women to sexual harassment. While the young women used various strategies to assert their autonomy, and challenge unequal gender norms, the prevailing male hegemony acted to subvert female sexual agency. Leveraging young urban migrants' desire to complete education, live independently and postpone motherhood may provide opportunities to examine and challenge gender norms and harmful practices.

Childhood encephalitis in the Greater Mekong region (the SouthEast Asia Encephalitis Project): a multicentre prospective study

BACKGROUND

Encephalitis is a worldwide public health issue, with a substantially high burden among children in southeast Asia. We aimed to determine the causes of encephalitis in children admitted to hospitals across the Greater Mekong region by implementing a comprehensive state-of-the-art diagnostic procedure harmonised across all centres, and identifying clinical characteristics related to patients' conditions.

METHODS

In this multicentre, observational, prospective study of childhood encephalitis, four referral hospitals in Cambodia, Vietnam, Laos, and Myanmar recruited children (aged 28 days to 16 years) who presented with altered mental status lasting more than 24 h and two of the following minor criteria: fever (within the 72 h before or after presentation), one or more generalised or partial seizures (excluding febrile seizures), a new-onset focal neurological deficit, cerebrospinal fluid (CSF) white blood cell count of 5 per mL or higher, or brain imaging (CT or MRI) suggestive of lesions of encephalitis. Comprehensive diagnostic procedures were harmonised across all centres, with first-line testing was done on samples taken at inclusion and results delivered within 24 h of inclusion for main treatable causes of disease and second-line testing was done thereafter for mostly non-treatable causes. An independent expert medical panel reviewed the charts and attribution of causes of all the included children. Using multivariate analyses, we assessed risk factors associated with unfavourable outcomes (ie, severe neurological sequelae and death) at discharge using data from baseline and day 2 after inclusion. This study is registered with ClinicalTrials.gov, NCT04089436, and is now complete.

FINDINGS

Between July 28, 2014, and Dec 31, 2017, 664 children with encephalitis were enrolled. Median age was 4·3 years (1·8-8·8), 295 (44%) children were female, and 369 (56%) were male. A confirmed or probable cause of encephalitis was identified in 425 (64%) patients: 216 (33%) of 664 cases were due to Japanese encephalitis virus, 27 (4%) were due to dengue virus, 26 (4%) were due to influenza virus, 24 (4%) were due to herpes simplex virus 1, 18 (3%) were due to Mycobacterium tuberculosis, 17 (3%) were due to Streptococcus pneumoniae, 17 (3%) were due to enterovirus A71, 74 (9%) were due to other pathogens, and six (1%) were due to autoimmune encephalitis. Diagnosis was made within 24 h of admission to hospital for 83 (13%) of 664 children. 119 (18%) children had treatable conditions and 276 (42%) had conditions that could have been preventable by vaccination. At time of discharge, 153 (23%) of 664 children had severe neurological sequelae and 83 (13%) had died. In multivariate analyses, risk factors for unfavourable outcome were diagnosis of M tuberculosis infection upon admission (odds ratio 3·23 [95% CI 1·04-10·03]), coma on day 2 (2·90 [1·78-4·72]), supplementary oxygen requirement (1·89 [1·25-2·86]), and more than 1 week duration between symptom onset and admission to hospital (3·03 [1·68-5·48]). At 1 year after inclusion, of 432 children who were discharged alive from hospital with follow-up data, 24 (5%) had died, 129 (30%) had neurological sequelae, and 279 (65%) had completely recovered.

INTERPRETATION

In southeast Asia, most causes of childhood encephalitis are either preventable or treatable, with Japanese encephalitis virus being the most common cause. We provide crucial information that could guide public health policy to improve diagnostic, vaccination, and early therapeutic guidelines on childhood encephalitis in the Greater Mekong region.

FUNDING

Institut Pasteur, Institut Pasteur International Network, Fondation Merieux, Aviesan Sud, INSERM, Wellcome Trust, Institut de Recherche pour le Développement (IRD), and Fondation Total.

The effects of season, geography, and urbanization on the diversity of edible insects at food markets in Laos

Laos, a mountainous and landlocked country located in Southeast Asia, has the highest percentage of people using insects as food in the world. Lao people obtain edible insects through harvesting in the natural environment and purchasing at food markets. There has been no comprehensive survey about sales of insects at food markets in the wider areas, and our understanding of sales of insects in Laos is limited. Our study aims to identify environmental factors affecting the sales and the diversity of edible insects sold at food markets in Laos. We visited 37 and 55 markets, during the dry and rainy seasons respectively, in northern Laos to record species of sold insects. We then analyzed the correlations between insect sales and three potential factors (seasons, provinces, and urbanization indices around the markets). There was no significant difference in the percentage of markets selling insects between in the dry and rainy seasons; 40–50% of the markets sold insects in both seasons. The composition of sold insects differed between in the dry and rainy seasons, which reflects the seasonality and life history of each insect species. There tended to be more groups of insects for sale in the Vientiane capital than in the other provinces in both seasons. This trend may reflect that it is more difficult to obtain edible insects through wild harvesting in highly urbanized Vientiane capital than in the other provinces, and the commercial demand for insects is increasing. This possibility is directly supported by the positive correlation between the urbanization index and the insect sales in the rainy season. Laos has recently undergone rapid urbanization, particularly in the Vientiane capital, and we predict that commercial demand for edible insects will be much higher in the Vientiane capital and the urbanized cities in the future.

Mechanisms to exclude local people from forests: Shifting power relations in forest transitions

Forest transitions may significantly contribute to climate change mitigation but also change forest use, affecting the local people benefiting from forests. We analyze forest transitions as contested processes that simplify multifunctional landscapes and alter local livelihoods. Drawing on the Theory of Access, we develop a conceptual framework to investigate practices of multifunctional forest use and the mechanisms that exclude local forest use(r)s during forest transitions in nineteenth century Austria and twenty-first century Lao PDR. Based on historical sources, interviews and secondary literature, we discuss legal, structural and social-metabolic mechanisms to exclude multifunctional forest practices, marginalizing peasants and shifting cultivators. These include, for example, the increasing enforcement of private ownership in forests or the shift from fuelwood to coal in Austria and restrictive land use planning or the expansion of private land concessions in Laos. By integrating political ecology and environmental history in forest transitions research we unravel shifting power relations connected to forest change.

Pooled testing of sputum with Xpert MTB/RIF and Xpert Ultra during tuberculosis active case finding campaigns in Lao People's Democratic Republic

INTRODUCTION

Active case finding (ACF) of individuals with tuberculosis (TB) is a key intervention to find the 30% of people missed every year. However, ACF requires screening large numbers of individuals who have a low probability of positive results, typically <5%, which makes using the recommended molecular tests expensive.

METHODS

We conducted two ACF surveys (in 2020 and 2021) in high TB burden areas of Lao PDR. Participants were screened for TB symptoms and received a chest X-ray. Sputum samples of four consecutive individuals were pooled and tested with Xpert Mycobacterium tuberculosis (MTB)/rifampicin (RIF) (Xpert-MTB/RIF) (2020) or Xpert-Ultra (2021). The agreement of the individual and pooled samples was compared and the reasons for discrepant results and potential cartridge savings were assessed.

RESULTS

Each survey included 436 participants, which were tested in 109 pools. In the Xpert-MTB/RIF survey, 25 (sensitivity 89%, 95% CI 72.8% to 96.3%) of 28 pools containing MTB-positive samples tested positive and 81 pools containing only MTB-negative samples tested negative (specificity 100%, 95% CI 95.5% to 100%). In the Xpert-Ultra survey, all 32 (sensitivity 100%, 95% CI 89.3% to 100%) pools containing MTB-positive samples tested positive and all 77 (specificity 100%, 95% CI 95.3% to 100%) containing only MTB-negative samples tested negative. Pooling with Xpert-MTB/RIF and Xpert-Ultra saved 52% and 46% (227/436 and 199/436, respectively) of cartridge costs alone.

CONCLUSION

Testing single and pooled specimens had a high level of agreement, with complete concordance when using Xpert-Ultra. Pooling samples could generate significant cartridge savings during ACF campaigns.

Validation of the Questionnaire on Sexual and Reproductive Health Literacy for Adolescents Age 15 to 19 Years in Lao People's Democratic Republic

Background:

Beyond sexual and reproductive health (SRH) knowledge, it is sexual and reproductive health literacy (SRHL) that reflects the capacity to deal with sexuality. Many interventions have been conducted to increase SRH knowledge in adolescents, but SRHL has rarely been measured, and a well-validated tool is needed to measure it. Objective: This study aimed to validate a tool to measure adolescent SRHL.

Methods:

Reliability, validity, and cultural equivalence were investigated using data from expert consultations, cognitive interviews, and two-pilot studies. Then adaptation was made to the SRHL questionnaire for correct use among Southeast Asian adolescents in Lao and in wider groups.

Key Results:

The SRHL tool was comprised of 39 question items focusing on teenage pregnancy, contraception, and abortion. Conceptual, item, and semantic equivalence were all met. Interviewer-administrated mode was found to be optimal. Each question offers the answer choices very difficult, difficult, easy, and very easy, with a good to excellent Cronbach's alpha (0.8–0.9); there were no missing items and no floor/ceiling effects. Construct validity was high as 6 of 7 hypotheses were confirmed.

Conclusion:

Validation was completed with good cross-cultural validity. The tool was shown to be effective in determining the level of SRHL in adolescents in Laos and potentially in other countries with similar cultures. [HLRP: Health Literacy Research and Practice. 2022;6(1):e37–e50.]

Plain Language Summary:

To find out how much adolescents know about sexual and reproductive health, an appropriate instrument of measurement is needed. Using different methods, we investigated the performance of a new tool, namely the SRHL questionnaire, which has 39 questions and should be used with an interviewer to assist in recording responses. This new tool could be used effectively to determine the level of literacy on sexual and reproductive health among adolescents.

Current assessment of the systematics and population genetics of Opisthorchis viverrini sensu lato (Trematoda: Opisthorchiidae) and its first intermediate host Bithynia siamensis sensu lato (Gastropoda: Bithyniidae) in Thailand and Southeast Asia

The group 1 carcinogen, the liver fluke Opisthorchis viverrini is the causative agent of opisthorchiasis and subsequent bile duct cancer (cholangiocarcinoma; CCA), which is an important public health problem in Southeast Asia. Bithynia snails are known to be the sole intermediate host of O. viverrini, and distributed throughout endemic areas of opisthorchiasis. Since 2001, the genetic variation investigation of O. viverrini has progressively been investigated. Comprehensive genetic variation studies of O. viverrini and Bithynia snails were undertaken and consecutively published in 2007 by Saijuntha and colleagues. These studies provided genetic evidence that O. viverrini and Bithynia snails are both species complex with evidence of co-evolution. Later, several studies have provided data in support of this finding, and have continuously to date reinforced that both O. viverrini and Bithynia are species complexes. Moreover, studies have shown that genetic variation of O. viverrini is related to geographical, temporal, fish host species including geographical genetic variation of its snail host, Bithynia siamensis sensu lato. This is significant and important in our understanding of the evolution and phylogenetic relationships between species within the O. viverrini and Bithynia species complexes. A comprehensive knowledge of the systematics and population genetics of O. viverrini and Bithynia snails provides a sound basis to instigate and develop effective prevention and control programs targeting opisthorchiasis and CCA in the endemic areas of Southeast Asia. Thus, this review examines the historical series of investigations of the systematics and population genetics of O. viverrini including Bithynia spp. in Southeast Asia since molecular genetic investigations commenced some 20 years ago.

Menstrual health and factors associated with school absence among secondary school girls in Luang Prabang Province, Lao People's Democratic Republic: A cross-sectional study

In Lao People’s Democratic Republic (Lao PDR), information on school sanitation and menstrual health among secondary school girls is limited. This study aimed to explore knowledge and practices surrounding menstrual health and to identify factors associated with school absence due to menstruation among secondary school girls in Lao PDR. The study involved 1,366 girls from grade 9 to grade 12 in six secondary schools in Luang Prabang Province. Data on socio-demographics and menstrual health of the girls and data on school toilets was collected. Logistic regression analysis was performed to identify the factors associated with school absence due to menstruation. The mean age was 15.8 years old. The average age of menarche was 12.9 years old. Of 1,366 girls, 64.6% were shocked or ashamed when they reached menarche and 31.8% had been absent from school due to menstruation in the six months before this study was conducted. Factors associated with school absence due to menstruation were age ≥ 16 years old (AOR = 1.79, 95% CI 1.37–2.34), higher income (AOR = 2.38, 95% CI 1.16–4.87), menstrual anxiety (AOR = 1.55, 95% CI 1.09–2.20), using painkillers (AOR = 4.79, 95% CI 2.96–7.76) and other methods (AOR = 2.82, 95% CI 1.86–4.28) for dysmenorrhea, and disposing used pads in places other than the school’s waste bins (AOR = 1.34, 95% CI 1.03–1.75). Living with relatives (AOR = 0.64, 95% CI 0.43–0.95) and schools outside the city (AOR = 0.59, 95% CI 0.38–0.90) were significantly less associated with school absence. Although the association between school toilets and school absence was not examined, the results of this study suggest that school toilets should be gender-separated and equipped with waste bins in the toilet. Furthermore, menstrual education should start at elementary schools and teacher training on menstrual health should be promoted.

Conservation planning on China's borders with Myanmar, Laos, and Vietnam

Transboundary conservation is playing an increasingly important role in maintaining ecosystem integrity and halting biodiversity loss caused by anthropogenic activities. However, lack of information on species distributions in transboundary regions and understanding of the threats in these areas impairs conservation. We developed a spatial conservation plan for the transboundary areas between Yunnan province, southwestern China, and neighboring Myanmar, Laos, and Vietnam in the Indo-Burma biodiversity hotspot. To identify priority areas for conservation and restoration, we determined species distribution patterns and recent land-use changes and examined the spatiotemporal dynamics of the connected natural forest, which supports most species. We assessed connectivity with equivalent connected area (ECA), which is the amount of reachable habitat for a species. An ECA incorporates the presence of habitat in a patch and the amount of habitat in other patches within dispersal distance. We analyzed 197,845 locality records from specimen collections and monographs for 21,004 plant and vertebrate species. The region of Yunnan immediately adjacent to the international borders had the highest species richness, with 61% of recorded species and 56% of threatened vertebrates, which suggests high conservation value. Satellite imagery showed the area of natural forest in the border zone declined by 5.2% (13,255 km² ) from 1995 to 2018 and monoculture plantations increased 92.4%, shrubland 10.1%, and other cropland 6.2%. The resulting decline in connected natural forest reduced the amount of habitat, especially for forest specialists with limited dispersal abilities. The most severe decline in connectivity was along the Sino-Vietnamese border. Many priority areas straddle international boundaries, indicating demand and potential for establishing transboundary protected areas. Our results illustrate the importance of bi- and multilateral cooperation to protect biodiversity in this region and provide guidance for future conservation planning and practice.

Environmental justice and REDD+ safeguards in Laos: Lessons from an authoritarian political regime

Balancing agendas for climate mitigation and environmental justice continues to be one of the key challenges in climate change governance mechanisms, such as Reducing Emissions from Deforestation and Degradation (REDD+). In this paper we apply the three-dimensional environmental justice framework as a lens to examine the REDD+ process in the Lao People's Democratic Republic (Laos) and the REDD+ social safeguards. We focus particularly on challenges to justice faced by marginalized communities living in forest frontier areas under an authoritarian regime. Drawing on policy analysis and open-ended interviews across different policy levels, we explore procedural, distributional, and recognitional justice across the REDD+ policy levels in Laos. We find that REDD+ social safeguards have been applied by both donors and state actors in ways that facilitate external control. We underscore how authoritarian regime control over civil society and ethnic minority groups thwarts justice. We also highlight how this political culture and lack of inclusiveness are used by donors and project managers to implement their projects with little political debate. Further obstacles to justice relate to limitations inherent in the REDD+ instrument, including tight schedules for dealing with highly sensitive socio-political issues under social safeguards. These findings echo other research but go further in questioning the adequacy of safeguards to promote justice under a nationally driven REDD+. We highlight the importance of recognition and political context, including aspects such as power relations, self-determination and self-governance of traditional or customary structures, in shaping justice outcomes.

WHO Systematic Assessment of Rehabilitation Situation (STARS): Results of the Field Testing in Jordan, Myanmar, Sri Lanka, Solomon Islands, Laos, Haiti, and Guyana

The WHO Systematic Assessment of Rehabilitation Situation (STARS) tool was developed by WHO to facilitate effective prioritization and strategic planning for rehabilitation in countries. The objective of this paper is to present the results of the fourth phase of its development, its field testing in seven countries focusing on its completeness, usefulness, accessibility and feasibility. Field testing occurred in Jordan, Myanmar, Sri Lanka, Solomon Islands, Laos, Haiti, and Guyana. Evaluation occurred through structured interviews and rating exercises with 17 government representatives, international consultants, WHO country or regional office staff and rehabilitation experts who were actively engaged and familiar with the STARS assessment and who were knowledgeable of the rehabilitation situation in the countries. STARS was appraised as relevant, complete and accurate in describing the country situation. Areas of inaccuracy were mostly linked to challenges in describing areas of services similarly when significant diversity existed. Feasibility and accessibility were mostly confirmed and more complex components of the tool as well as the guidance to the assessment process were slightly revised in light of the field-testing results. The field testing of WHO STARS confirmed its completeness, usefulness, accessibility and feasibility, and concerns raised by the interviews informed the last refinement of the tool. STARS is part of the WHO Rehabilitation in Health Systems-Guide for Action, available online, by September 2021, STARS had guided 21 country situation assessments.

Antimicrobial use and resistance data in human and animal sectors in the Lao PDR: evidence to inform policy

OBJECTIVES

To review the scientific evidence base on antimicrobial use (AMU) and antimicrobial resistance (AMR) in human and animal sectors in the Lao PDR (Laos).

METHODS

We reviewed all publications from July 1994 (the first article describing AMR in Laos) to December 2020. Electronic searches were conducted using Google Scholar and PubMed with specific terms relating to AMR and AMU in Lao, French and English languages.

FINDINGS

We screened 1,357 peer-reviewed and grey reports by title and abstract and then full articles/reports. Of 80 included, 66 (83%) related to human health, nine (11%) to animal health, four (5%) to both animal and human health and one (1%) to the environment. Sixty-two (78%) were on AMR and 18 (22%) on AMU. Extended spectrum beta lactamase-producing Escherichia coli was the greatest concern identified; the proportion of isolates increased fivefold from 2004 to 2016 (2/28 (7%) to 27/78 (35%)) from blood cultures submitted to the Microbiology Laboratory, Mahosot Hospital, Vientiane. Carbapenem resistant Escherichia coli was first identified in 2015. Methicillin-resistant Staphylococcus aureus (MRSA) was uncommon, with 15 cases of MRSA from blood cultures between its first identification in 2017 and December 2020. AMR patterns of global antimicrobial resistance surveillance system (GLASS) target pathogens from livestock were less well documented. There were few data on AMU in human health and none on AMU in livestock. The first hospital AMU survey in Laos showed that 70% (1,386/1,981) of in-patients in five hospitals from 2017 to 2018 received antimicrobial(s). Antibiotic self-medication was common.

CONCLUSION

AMR in Laos is occurring at relatively low proportions for some GLASS pathogens, giving the country a window of opportunity to act quickly to implement strategies to protect the population from a worsening situation. Urgent interventions to roll out new guidelines with enhanced one-health antibiotic stewardship, reduce antibiotic use without prescriptions, enhance surveillance and improve understanding of AMU and AMR are needed.

Zootherapeutic uses of animals excreta: the case of elephant dung and urine use in Sayaboury province, Laos

BACKGROUND

Despite a widespread aversion towards faeces and urine, animal excreta are used in traditional medicine in many countries since centuries, but records are scattered and few therapeutic uses have been accurately documented while in the current context of emerging zoonoses such records may be of major interest.

METHODOLOGY

In this study, we investigated the therapeutic uses that mahouts in Xayaboury province, Lao PDR make of elephant urine and faeces as well as of the brood chamber that beetles (Heliocopris dominus) fashion from elephant dung. Semi-structured interviews were conducted with mahouts on elephant diet, health problems and responses to disease, andwhether they use elephant products. Data were supplemented by interviews with traditional healers.

RESULTS

Seven respondents reported the use of elephant urine in ethnoveterinary care for elephants and in human medicine in case of diabetes and otitis. 25 respondents reported therapeutic use of elephant faeces (EF) and elephant dung beetle brood chambers. The major indications are gastrointestinal and skin problems. Macerations or decoctions are drunk or used externally as a lotion. The mahouts attribute the therapeutic effectiveness of EFs to their content which includes the remains of many species from the elephant diet which they consider to be medicinal.

DISCUSSION

The indications of these uses are consistent with pharmacological and clinical studies highlighting the properties of different animals' urine and faeces and their curative potential tested in vivo. The acknowledgement by the mahouts of medicinal properties of elephant faecal bolus contrasts with the rare justifications of animal material use recorded in zootherapeutic studies, which falls within the symbolic domain. However, numerous studies highlight the preponderant role of the microbiota in physiological processes, raising the hypothesis of a curative action of EF, by rebalancing the user's microbiota.

CONCLUSION

The therapeutic uses of EF preparations despite their possible curative properties are a potential source of zoonotic transmission from elephants to humans. In the current context of globalisation of trade which favours the emergence of zoonoses and in relation with the issue of One Health, it becomes crucial to further document the zootherapeutic practices to prevent emerging diseases. As elephants and local related ethnoethological knowledge are threatened, documenting them is urgent to contribute to their preservation.

Individual responses to a single oral dose of albendazole indicate reduced efficacy against soil-transmitted helminths in an area with high drug pressure

BACKGROUND

Albendazole (ALB) is administered annually to millions of children through global deworming programs targeting soil-transmitted helminths (STHs: Ascaris lumbricoides, Trichuris trichiura and hookworms, Necator americanus and Ancylostoma duodenale). However, due to the lack of large individual patient datasets collected using standardized protocols and the application of population-based statistical methods, little is known about factors that may affect individual responses to treatment.

METHODOLOGY/PRINCIPAL FINDINGS

We re-analyzed 645 individual patient data from three standardized clinical trials designed to assess the efficacy of a single 400 mg oral dose of ALB against STHs in schoolchildren from different study sites, each with varying history of drug pressure based on duration of mass drug administration programs: Ethiopia, low; Lao People's Democratic Republic (PDR), moderate; Pemba Island (Tanzania), high. Using a Bayesian statistical modelling approach to estimate individual responses (individual egg reduction rates, ERRi), we found that efficacy was lower in Pemba Island, particularly for T. trichiura. For this STH, the proportion of participants with a satisfactory response (ERRi ≥50%), was 65% in Ethiopia, 61% in Lao PDR but only 29% in Pemba Island. There was a significant correlation between ERRi and infection intensity prior to drug administration (ERRi decreasing as a function of increasing infection intensity). Individual age and sex also affected the drug response, but these were of negligible clinical significance and not consistent across STHs and study sites.

CONCLUSIONS/SIGNIFICANCE

We found decreased efficacy of ALB against all the STHs analyzed in Pemba Island (Tanzania), an area with high drug pressure. This does not indicate causality, as this association may also be partially explained by differences in infection intensity prior to drug administration. Notwithstanding, our results indicate that without alternative treatment regimens, program targets will not be achievable on Pemba Island because of inadequate efficacy of ALB.

TRIAL REGISTRATION

The study was registered on Clinicaltrials.gov (ID: NCT03465488) on March 7, 2018.

Pesticides use and health impacts on farmers in Thailand, Vietnam, and Lao PDR: Protocol for a survey of knowledge, behaviours and blood acetyl cholinesterase concentrations

Pesticides use in Southeast Asia has increased steadily, driven by the growth of large-scale commercial farming, as well as a desire to maximise food production in rural subsistence economies. Given that use of chemical pesticides, such as organophosphates and carbamates, has known potential health impacts, there are concerns about the safety of agricultural workers, and a need for a better evidence base to underpin regulation and worker education. This study, undertaken in 9 districts in Lao PDR, Thailand and Vietnam, will interview agricultural workers to investigate how they use pesticides, their knowledge of risks and self-protective practices, and their self-reported illness symptoms. In each district researchers will recruit and interview 120 participants engaged in vegetable farming, who have recently used pesticides, making a total of 1080 subjects divided equally between the three study countries. Workers’ degree of pesticides exposure will be determined from acetyl cholinesterase concentrations in capillary blood samples collected using field test kits, and these data will be analysed together with the interview findings. Country findings will be compared and contrasted, and general patterns noted. Knowledge gained about risky behaviours, self-protective practices and degree of association with serious pesticides exposure will assist policy makers and inform health improvement programmes.

Integrated Management of Neonatal and Childhood Illness Training in Lao PDR: A Pilot Study of an Adaptable Approach to Training and Supervision

Integrated Management of Neonatal and Childhood Illness (IMNCI) has been part of the national strategy for child health in Lao Peoples Democratic Republic since 2003. The program, while running for an extended period, has faced multiple challenges including maintaining the teaching quality for the implementation of the IMNCI guidelines and a structure to enable and support healthcare workers trained to apply the training in their workplace. A revised training model that focused on building skills for teaching according to adult learning principles in a pool of facilitators, a practical and hands-on training workshop for healthcare workers, and the establishment of a program of health center supervision was developed and implemented in three provinces. Participants in the revised model reported increased confidence in implementing IMNCI guidelines, they demonstrated competence in the steps of IMNCI and on follow-up assessment at a supervision visit were found to have improved patient care through the measurement of pediatric case management scores. This study highlights the importance of a focus on education to ensure the translation of guidelines into practice and thereby lead to improvements in the quality of pediatric care. The IMNCI training approach is acceptable and valued by healthcare worker participants.

Detection of African swine fever virus in free-ranging wild boar in Southeast Asia

African Swine Fever (ASF) is a highly contagious and fatal viral disease affecting both domestic and wild suids. The virus was introduced to Southeast Asia in early 2019 and has since spread rapidly throughout the region. Although significant efforts have been made to track and diagnose the disease in domestic pigs, very little is known about ASF in free-ranging wild boar and their potential role in maintaining the disease within Southeast Asia. Through a collaboration between government and non-government actors in Laos, Viet Nam, and Cambodia, investigations were conducted to (a) characterize the interface between domestic pigs and wild boar, (b) document risk factors for likely ASF spillover into wild boar populations by way of this interface, and (c) determine whether ASF in wild boar could be detected in each country. An extensive overlap between wild boar habitat and domestic pig ranging areas was found around villages bordering forests in all three countries, creating a high-risk interface for viral spillover between domestic pig and wild boar populations. Fifteen and three wild boar carcasses were detected through passive reporting in Laos and Viet Nam, respectively, in 2019 and early 2020. Four of five carcasses screened in Laos and two of three in Viet Nam were confirmed positive for African swine fever virus using real-time PCR. There were no confirmed reports of wild boar carcasses in Cambodia. This is the first confirmation of ASF in wild boar in Southeast Asia, the result of a probable viral spillover from domestic pigs, which highlights the importance of early reporting and monitoring of ASF in wild boar to enable the implementation of appropriate biosecurity measures.