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@#Background: Global guidelines from the World Health Organization on discharging patients diagnosed with COVID-19 changed in 2021 to a symptom-based rather than negative PCR-based approach. Studies have shown that shedding of viable virus continues for approximately eight days after symptom onset in most patients. In Vientiane, Laos, until now, patients diagnosed with asymptomatic or mild COVID-19 are hospitalised for 2 weeks and then, if they still test PCR positive for SARS-CoV-2, stay for a further week in a designated quarantine hotel before being discharged home. Objective: The aim of this pilot study was to investigate the risk of transmission of SARS-CoV-2 to household contacts of discharged patients who are still PCR-positive following 2-3 weeks quarantine in Vientiane, Lao PDR. Methods: Adult participants, who were resident in Vientiane Capital and who were about to be discharged from hospital (after 2 weeks hospitalisation), or from a quarantine hotel, following a further one-week quarantine, were screened to assess eligibility for the study. The household of each case was visited a maximum of 48 hours before or up to 24 hours after the participant was discharged and a nasopharyngeal swab was taken from all household members. Repeat nasopharyngeal swabs from cases and contacts were taken on day 7 and day 14 after discharge home of each case. Results: Between 20th May 2021 and 27th August 2021, 55 cases and 84 contacts in 27 households were enrolled in the study. The median [range] age of all 139 included participants was 26.5 years [3 months to 83 years] and 83 (60%) were female. By household, the median [range] number of cases and contacts were 1 [1- 6] and 3 [1-13] respectively. At discharge home 32/48 (67%) cases tested positive for SARS-CoV-2. By day 7 11 of 47 cases (23%) still tested positive for SARS-CoV-2 by PCR and by day 14 this number was 2/24 (8%). No contacts tested positive during follow up and the numbers tested at the time of discharge of the case, 7 days later and 2 weeks later were 56, 57 and 37 respectively. Loss to follow up at day 7 and day 14 ranged from 15-50% (participants not at home at the time of visits). Conclusion: In this pilot study we found no evidence of onward transmission of SARS-CoV-2 to contacts of cases discharged home with a positive PCR result. This suggests the current discharge policy for mild to moderate COVID-19 case following 2 weeks in hospital in the Lao PDR is safe.
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@#Objective: The aim of this paper is to assess the interactions between migration paths and HIV infection risks among and from the views of people living with HIV in Lao PDR. Methods: Twenty-four in-depth interviews with eight interviewees were carried out by four trained members of the Association of People Living with HIV (APL+), in 2017. The qualitative analysis was done manually to explore the influence of social determinants through migratory paths on the evolution of individual lifestyles, working and living environments, access to information, prevention and healthcare that contribute to HIV infection risks. Results: Low levels of economic and education lead to migration and also increase risky practices and vulnerability to HIV infection of migrant workers. Insufficient awareness and access to prevention against HIV/STIs in their home country increase risky behaviours during migration. Moreover, inadequate referral system for HIV treatment, stigma, and family relationships contribute to influence the life courses of migrants' post-HIV infection. Conclusions: Raising awareness and providing access to information on HIV/STIs, both for internal and external migrant workers are crucial in order to diminish the prevalence of HIV infection among the target audience. A reinforcement of the existing collaborative health measures between Lao PDR and Thailand is needed to enhance migrants’ access to healthcare services.
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@#Background: Outbreaks of vaccine preventable-disease control and elimination are impeded by impaired focal vaccination uptake. Therefore, we aimed at assessing vaccination uptake and comparing with passive surveillance (PS) report at village level. Methods: A community-based cross-sectional survey was conducted in the villages covered by two health centers in Bolikhamxay province, including non-Hmong and Hmong ethnic groups. Data collection was conducted by interviewing mothers or caregivers of children aged 6 to 23 months. The vaccination status was identified by vaccination cards, and compared with PS report at village level, which was collected from health centers. The Pearson’s chi-square test was used to compare these proportions, and pairwise correlation was used for the correlation of observed vaccination coverage. Finding: Sixteen villages were included, nine were from Luk52 health center area and 7 from Namkhou health center area. There was a significantly strong correlation for pentavalent pneumococcal conjugate vaccine, Japanese encephalitis, Measles and Rubella and full immunization coverage compared to others. This correlation was not observed in the non-Hmong population. Amongst non-Hmong, the recorded coverage was lower in PS than in the survey regardless of type of vaccine. In contrast, amongst Hmong most vaccines had higher recorded coverage in PS than in the survey except Bacillus Calmette–Guérin (BCG) and hepatitis B at birth dose. MR and JEV vaccine, commonly given at the same time, were the only one that did not have significantly different coverage between PS and the survey (p<0.334). Conclusion: The mis-estimatation of immunization coverage from the PS reporting system highlights further research needed to determine a better indicator of village-level vaccination coverage, but measles could be an indicator of prioritizing the settings.
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@#Objective: we aimed to investigate the possible causes of death among preterm and LBW infants admitted to the post-delivery ward and/or NICU at Mahosot Hospital, Lao PDR, and the possible factors that influence preterm and LBW infants’ survival. Methods: A retrospective cross-sectional study was conducted between by reviewing the treatment and outcomes for preterm and LBW infants admitted July - November 2017 to Mahosot Hospital in Vientiane, Lao PDR. Results: Of 3,500 births in 2017, 224 (6.4%) were preterm, 350 (9.4%) were LBW and 106 (30.2%) were term LBW; 98 preterm births (43.8%) and 21 (19.8%) term LBW babies were admitted to the NICU. Enrolment included 93 cases including 86 (92.5%) preterms and 7 term LBW neonates, of whom 47 (54.7%) and 2 were admitted to NICU, respectively. Enrollees were mostly male, Lao Loum, born vaginally at Mahosot Hospital; 3.2% were extreme preterm, 15.1% were very preterm, 74.2% moderate to late preterm and 7.5% term LBW; 2.2% were extremely LBW, 16.1% very LBW, 63.4% LBW and 18.3% normal birth weight. All 44 (47.3%) preterm or LBW babies admitted to the postnatal ward survived. Of the 49 (52.7%) admitted to the ICU, 18.4% died. All neonates who died were preterm of gestational age ranging 25-36 weeks and birth weight 730-2220g. Babies admitted to the NICU were mostly diagnosed with respiratory distress syndrome (RDS, 39.7%), neonatal infections (31.7%), asphyxia (9.5%) and congenital malformations (4.8%). Patient care. Antenatal: 5.9% of preterm births <32 weeks received magnesium sulfate, and 27% of births 24-34 weeks gestational age received antenatal steroids. Postnatal: 37.6% received skin-to-skin contact (SSC), and 15% maintained SCC until breastfeed completed, 68.8% received exclusive breastmilk as first feed and 24.5% kangaroo mother care. Only 7.5% were monitored for hypoxemia and 24.7% for hypothermia. Weights were not checked prior to discharge. Case management: Around two-thirds of babies with risk factors for sepsis received prophylactic antibiotics. Most (77.6%) babies during the NICU admission received antibiotics, all of whom had a CBC and blood culture; but half without a diagnosis of sepsis or risk factors. Most (79.6%) preterm and LBW babies admitted to the NICU were given oxygen. About one-quarter of babies with RDS died. Very LBW infants rarely received supplementation with vitamin D, phosphate, iron and calcium. Conclusions: Most study participants were late preterm and LBW. Just under 10% died. Care can be improved, including antenatal administration of magnesium sulfate and antenatal steroids that needs to be vastly increased for eligible mother in preterm labor. Respiratory management needs further investigation for gaps. Feeding with breastmilk and checking vital signs appear to be strengths.
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@#Objective: we aimed to assess the knowledge, attitude and practice (KAP) of healthcare providers (HCP) towards cervical cancer (CC) screening and to identify possible factors associated with its low utilization among women presenting at gynaeco-obstetrics units in the Lao PDR. Methods: A cross-sectional study was conducted between March - June 2018 on a sample of 85 (HCP) at gynaecology units in two provincial and eleven district hospitals in Luang Prabang (LPB) and Salavan (SLV) Provinces. Results: Of the 85 HCP, 63.4% were from SLV and 36.6% from LPB. 81% were females and mean ager was 32 years. Only 7% of them had good knowledge, 18.8% had good CC screening attitudes and only 1.2% had good CC screening practices. 36.2% of female HCP had been screened for CC and 48.3% had not been screened because they thought only those who had symptoms and risk factors should go for. The most common reasons for not conducting routine CC screening of patients were: lack of medical equipment (53.7%), and incompetent techniques (43.3%). HCP graduates and post graduates had a higher knowledge score (aOR = 4.09, 95% CI: 1.43-11.66, P = 0.008), and attitude score (aOR = 5.54, 95% CI: 1.55-19.75, p=0.008). Those, who had been working for more than 10 years, were more likely to have higher attitude scores (aOR = 6.07, 95% CI: 1.36-27.15, p =0.018). Conclusions: CC screening knowledge among HCP is generally fair. However, CC screening attitudes are still poor. Re-orientation courses on CC screening for HCP are urgently needed in order to move forward to the next steps in CC screening programs.
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@#Background: Diabetes Mellitus (DM) is a major public health concern, but with minimal data on how this affects the Lao population. We aimed at predicting the impact of the burden of DM, and determine the effectiveness of DM screening techniques to reduce related mortality in Lao PDR. Methods: A compartmentally deterministic model was created to reflect the demography in 2005 and 2015, and DM prevalence in 2015 of the Vientiane capital population. The parameters were retrieved from calibration and literature reviews. The model predicted demographic structure and DM in 2035. The effectiveness of DM screening tests, either Fasting Plasma Glucose (FPG) or glycated hemoglobin (HbA1c), was examined in term of mortality reduction. Results: By 2035, the Vientiane population is expected to have annual grow of 0.89% with higher proportion of more elderly people; those aged 45 years old and older are expected to account for 39.3% in 2035. Overall prevalence of DM was expected to rise from 9.65% in 2015 to 13.4% in 2035 as a result of the aging population. The model predicts that the prevalence of DM would double (28.42%) in those aged >60 years old by 2035. The mortality rate is expected to increase more than double from 890 in 2015 to 1,808 deaths per 100,000 people in 2035, with the highest rate in those with undiagnosed diabetes and those older than 60 years. Screening by FPG test at an initial age of 35 years old is estimated to reduce mortality by 17.93%, and 16.80% for initial age screening at 45 years. Screening by HbA1c test would slightly increase the mortality reduction by approximately 1.20% at both initial screening ages. Conclusion: This mathematical modeling projected the steadily increase of prevalence and death related to DM over 30 years of simulation. Early screening by glycemia would reduce the mortality.
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@#Emphysematous Pyelonephritis (EPN) is an uncommon but life-threatening condition for which diabetic patients are at high risk. The most common chief complaint bringing patients to the hospital is upper urinary tract infection. Early clinical diagnosis with radiography is a key to reduce the complications and death due to emphysematous pyelonephritis. We present a case study of a 45-year old female patient who was presenting to the emergency room with left flank pain. Blood testing showed acute kidney injury, E. coli bacteremia, and the radiography demonstrated an abnormal image of the left kidney consistent with EPN. Symptomatic treatment and antibiotic were given, but no response and developed to heart failure and death at Emergency Room.
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Background@#Hypertension in children is one of major concerns in public health. However, there is no evidence within the Lao population. Therefore, we aimed to determine the prevalence of hypertension in children and adolescents aged 11-15 years old.@*Methodology@#A descriptive, cross-sectional study was conducted in children and adolescents aged 11-15 years old at secondary schools of Vientiane Capital, Lao PDR. Two secondary schools were purposively selected, Vientiane and Bornagnao schools. The data were collected using questionnaire form.@*Result@#A total of 365 students were included in the study of which 50.7% were male. The mean age was 13.7 years old (Min=11 and Max=15). The majority of students were of Lao Loum ethnicity (95.1%). Of 365 students, 140 (38.3%) had high blood pressure during the survey. Of these, 99 (27.1%) people were at pre-hypertension, 6.3% in stage 1 and 4.9% in stage 2. Most (74.5%) of included students had normal Body Mass Index (BMI). Students with overweight and obesity were significantly more likely to have hypertension than others (p<0.001).@*Conclusion@#We found a high prevalence of hypertension in secondary school students particularly in those overweight and obese. Therefore, it is important to provide appropriate education at school to reduce the risk factors as well as hypertensive screening.
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Background@#Acute glomerulonephritis (AGN) occurs in all age groups and any settings around the world. AGN is a major cause of illness and death in children. However, the signs and symptoms are not specific for the disease.@*Objective@#To study the treatment and outcome of Acute Glomerulonephritis in children, at Pediatric ward, Mahosot Hospital@*Methodology@#A retrospective study was conducted to review the medical records of inpatients admitted to the Pediatric Ward at Mahosot Hospital from January 2014 to January 2017. All patients aged 15 years old or younger with complete medical records were included in the study. The information on signs and symptoms, laboratory results, treatment and outcome of the patients with acute glomerulonephritis were descriptively analyzed and reported.@*Finding@#There were 3,528 patients admitted to the Pediatric Ward at Mahosot Hospital during the three years. Among these, 64 patients were diagnosed as having AGN (1.81%), but only 36 cases met the study inclusion criteria. The proportion of males was slightly higher than females (ratio 1.2:1) with the mean (SD) age of 9.6 (±2.7 years old) years old. More than a half (53.57%) of the patients reported a medical history of pharyngitis or tonsillitis. The most common presenting symptoms and signs were edema (94%), hematuria (25%), anuria (36%) and hypertensive emergency (17%). The key abnormally elevated renal function tests included BUN (44%) and creatinine (28%). The most common complications included hypertensive encephalopathy (25%) and congestive heart failure (8%).@*Conclusion@#AGN is the major cause of acute kidney injury, congestive cardiac failure and hypertensive encephalopathy, which require optimal treatment in order to have a good outcome.
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Background@#The prevalence of Autoimmune Hemolytic Anemia (AIHA) globally ranges from 5-30%, but relatively high in Asia, 22%. This condition is commonly found among patients with thalassemia. However, no data are available about this disease in Lao PDR.@*Objective@#To determine the proportion of AIHA among Lao children with thalassemia.@*Methodology@#A cross-sectional study was conducted from May to September 2018 in pediatric patients with thalassemia who received blood transfusion at the Children’s Hospital, Vientiane Capital. There were 338 patients included in the study. Data analysis was done using SPSS, and Pearson chi-square was used to compare the two proportions.@*Finding@#We found that the proportion of AIHA was 3.6% (12/336) amongst those with thalassemia with more males than females (3:1). The mean (SD) age was 11.5 ± 3 years old. The older age of patients was significantly associated with AIHA, p=0.001. We also found that patients with transfusion dependent thalassemia were more likely to have AIHA than those who were not. The mean reticulocyte count (%) was significantly higher in patients with AIHA than those without AIHA (8.61±10.57 versus 1.18±1.14, p<0.001). Other variables such as sex, type of thalassemia, age at diagnosis, the frequency of blood transfusion, age at first blood transfusion, blood group and hemoglobin before blood transfusion were not significantly associated with AIHA.@*Conclusion@#The proportion of AIHA remains low in Lao children with transfusion dependent thalassemia, but requires further attention to reduce its complications. There is a need to identify factors associated with AIHA among Lao patients with Transfusion Dependent Thalassemia
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Background@#Laos has a high prevalence of hepatitis B infection, at about 8% of the population. Hepatocellular carcinoma (HCC) caused by this virus could be significantly reduced by the primary prevention and early treatment of patients with chronic hepatitis B.@*Objective@#To describe the levels of viral load in patients with chronic Hepatitis B before and after antiretroviral (ARV) treatment in Lao PDR.@*Methodology@#A retrospective descriptive study was conducted by reviewing the laboratory records of 135 patients with chronic hepatitis B registered from January 2010 to August 2013 at the Christrophe Merieux Infectiology Centre, Vientiane Capital, Lao PDR. Hepatitis B viral load (VL) was determined by PCR before and after treatment initiation among this population. Pearson chi-square and Wilcoxon tests were used to compare the proportions and geometric mean.@*Result@#Among 135 hepatitis B patients, most (88%) of the patients were from referral hospitals in Vientiane Capital. 65% were male, and 55% were given ARV without VL testing. Among these, Cycloferon (an immunomodulator) was the commonly used (57%), which is not yet recommended by the Asian Pacific Association for the Study of the Liver Guidelines (APASL). The VLs of patients treated with ARV and Immunomodulator were significantly reduced from the baseline after 4 months. Patients treated with ARV alone had significantly lower geometric mean VL [IC 95%] 4 months after treatment initiation than those treated with Immunomodulator (3.53 [2.81-4.2] versus 4.14 [2.99-5.29]; p<0.001), and those treated with a combination of ARV and Immunomodulator (Geometric mean of VL: 3.53 [2.81-4.2] versus 4.82[3.8-5.8]; p=0.035). Our study found that there was no significant difference in VL between Immunomodulator and ARV+ Immunomodulator (4.14 [3-5.2] versus 4.82 [3.8-5.8]; p=0.371).@*Conclusion@#ARV and Immunomodulator treatment is effective in reducing HBV VL, but ARV works more effectively than when used in combination with Immunomodulator and for Immunomodulator alone. There is an urgent need of developing Lao consensus hepatitis B treatment guidelines and good clinical practice implementation.
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Introduction@#Diarrhea is the most common disease of children particularly in those under 5 years old. In Lao PDR, diarrhea is responsible for 12% of all childhood deaths and the disease is increasing. Therefore, there is a need to study optimal disease management in Lao patients@*Methodology@#A retrospective study was carried out by reviewing medical records of patients admitted at the Pediatric Infectious Ward, Mahosot Hospital, Vientiane Capital from 01/01/2017 to 31/06/2018. We included those diagnosed with acute diarrhea aged 15 years old or younger.@*Finding@#Three hundred and seventy children with diarrhea were included in the analyses, with a higher proportion of males than females [230 (62.2%), 140 (37.6%)] with a ratio of 1.6:1. Mean (SD) age of the patients was 2.1±2.33 years old. The most common age group was those < 2 years old with 247 cases (66.8%), followed by the age group of 2-5 years old [92 cases (24.9%)], 5-10 years old [25 cases (6.8%)] and 10-15 years old [6 cases (1.6%)]. The management in patients without clinically-evident dehydration was ORS in 161 (98.7%), IV fluid in 115 (71.5%) and antibotics in 12 (7.4%). For patients with moderate dehydration, the management consisted of giving ORS in 370 (100%), IV fluid in 198 (96%) and antibotics in one (0.5%). One patient with severe dehydration was given ORS and IV fluid.@*Conclusion@#High proportion of diarrhea found in children under 5 years old. Management in patients without clinical dehydration were rehydration with ORS and IV fluid because patients refused to drink ORS.
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@#This is a policy brief article on the prediction of Covid-19 outbreak and its prevention and control for the possible second wave in the Lao PDR. Compartmental dynamic modeling was created to reflect the natural history of Covid-19. This included susceptible, symptomatic and asymptomatic states and recovery or death. The simulation was done for one year and with two scenarios: 1) high transmission level (R0=5.2) and 2) mid -transmission level (R0=2.0). The model output showed that the size of the outbreak depended on the transmission level, and could reach to 85% of the Lao population with high transmission scenario. However, disease burden was predicted to be smaller with the interventions. Among these, voluntary home quarantine was found to be the most effective, but the predication reverses in the mid-level transmission scenario. Social distancing is much more effective. If there are imported COVID-19 cases, a new wave could occur in two weeks to 2 months, depending on the size of pandemic and efficacy of the rest of interventions. Mid-level lockdown would result in new epidemic starting by July 2020, but the number of infected people would be less if travel bans and social distancing are maintaining. Only high-level lockdown would be able to stop community transmission in the country.
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Background and Rational@#Open trades in Lao PDR leads to many imported goods. Lacking capacity with international standards for inspecting and validating the imported goods at border check point would harm consumers.@*Methodology@#A descriptive study was conducted to assess the opinions and practice towards the staff of food and drug administration at 16 check points in Lao PDR using self-administered questionnaire from March to June 2015.@*Result@#The detection and validation were done based on food categories, which included raw food, canned food and other prepared food. There are 5 steps of validation: 1) checking documents at the checking point; 2) checking food; 3) seizing food; 4) releasing food and 5) reporting. The staff reported that documents should include name of food, label, certificate of food quality, certificate of laboratory sample analysis, certificate of importation permission, invoice and packaging list. Meanwhile, checking food includes the random selection of product for screening tests, particularly raw food. The suspected contaminated food will be verified at the main laboratory. Then, the suspected contaminated food was seized until the result of the laboratory are available. The foods from those who had the history of contaminated food importation should be randomly tested. The contaminated foods were recorded as blacklisted in order to facilitate next importation in detecting and validating the quality of food. Any update regulations should inform to the importers. The food and drug administrators at checkpoints had a good practice based on Lao regulations. However, some materials need to be improved. The detection form needs to be separated according to the food categories. They need more test kits, random detection guidelines, guidelines for laboratory tests, guidelines for detecting high-risk contaminated food, tools and materials of inspection. Moreover, there is a need of short and long-term training on using detection tool kits, random selection and reporting system.@*Conclusion@#There are different methods of inspection of imported food at checking point of Lao PDR. The international checking point had better quality than the other one.
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We identified the echinostome metacercariae in Chinese mystery snails, Cipangopaludina chinensis malleata, from Xiengkhuang Province, Lao PDR with morphologies of adult worms recovered. Total 20 snails were examined with artificial digestion method and then the collected metacercariae were orally infected to a mouse and a rat. Adult worms recovered from experimental animals were observed with a light microscope and a SEM. The metacercariae were round, 125×123 μm in average size, with a moderately thick cyst wall, collar spines distributed in the head collar and excretory granules in 2 canals of excretory tube. Adult flukes (3-week-old in a rat) were elongated, ventrally curved and 5.310×1.023 mm in average size. Head collar distinct, bearing 43 collar spines with 5 end group ones on each side. Oral sucker subterminal, prepharynx very short, pharynx well developed, and esophagus relatively short. Cirrus sac well developed, with a saccular seminal vesicle, and ventral sucker very large. Ovary round and on the median line of the body. Testes tandom and elongated. Eggs operculated, elliptical and 90×57 μm in average size. In the SEM observation, the head crown prominent, with 43 collar spines resembled with horns of younger stag. Scale-like tegumental spines were densely distributed on the surface between the head collar and ventral sucker, and their densities were decreased posteriorly. Conclusively, the metacercariae detected in C. chinensis malleata from Lao PDR were identified as those of Echinostoma macrorchis based on the morphological characteristics of adult worms.
Subject(s)
Adult , Animals , Female , Humans , Mice , Rats , Asian People , Crowns , Digestion , Echinostoma , Eggs , Esophagus , Head , Horns , Metacercariae , Methods , Ovary , Ovum , Pharynx , Seminal Vesicles , Snails , Spine , Testis , TrematodaABSTRACT
Adult specimens of Echinochasmus caninus n. comb. (Verma, 1935) (Trematoda: Echinostomatidae) (syn. Episthmium caninum Yamaguti, 1958) were recovered from 11 riparian people who resided along the Mekong River in Khammouane Province, Lao PDR. In fecal examinations done by the Kato-Katz technique, the cases revealed eggs of Opisthorchis viverrini/minute intestinal flukes, hookworms, and in 2 cases echinostome eggs. To recover the adult helminths, praziquantel 30–40 mg/kg and pyrantel pamoate 10–15 mg/kg in a single dose were given and purged with magnesium salts. Various species of trematodes (including O. viverrini and Haplorchis spp.), cestodes, and nematodes were recovered from their diarrheic stools. Among the trematodes, small echinostome flukes (n=42; av. 3.8 specimens per case) of 0.7–1.2 mm in length are subjected in this study. They are morphologically characterized by having 24 collar spines interrupted dorsally and anterior extension of vitellaria from the cirrus sac or genital pore level to the posterior end of the body. Particularly based on this extensive distribution of vitellaria, the specific diagnosis was made as Echinochasmus caninus. The cases were co-infected with various other helminth parasites; thus, clinical manifestations specific for this echinostome infection were difficult to determine. The present paper describes for the first time human E. caninus infections in Lao PDR. Our cases marked the 4–14th human infections with this echinostome around the world following the 3 previous cases reported from Thailand.
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Adult , Animals , Humans , Ancylostomatoidea , Cestoda , Comb and Wattles , Diagnosis , Eggs , Helminths , Magnesium , Opisthorchis , Ovum , Parasites , Praziquantel , Pyrantel Pamoate , Rivers , Salts , Spine , Thailand , TrematodaABSTRACT
Introduction@#In recent years, the incidence of measles has declined in the Lao People’s Democratic Republic. However, an outbreak was reported in August 2014 in Houaphanh province, which was the biggest outbreak in the country since 2008. We describe the characteristics of this outbreak and outline critical interventions for the Lao People’s Democratic Republic to achieve measles elimination.@*Methods@#Fever and rash cases in the Khouan and Samtai districts with an onset date from 1 September to 25 October 2014 were investigated. Active case finding and health facility record reviews were carried out. Appropriate samples from the individuals with suspected measles were tested to confirm the diagnosis.@*Results@#A total of 265 suspected cases including 12 deaths were reported from eight villages in the Khouan and Samtai districts. Forty-five individuals tested positive for measles IgM. Most of the confirmed patients were male (n = 28, 62%), less than 5 years old (n = 23, 51%) and from the Hmong ethnic community (n = 44, 98%). The majority of the people with suspected measles (n = 213, 80%) and all the confirmed ones were unvaccinated. A measles vaccination campaign conducted in the eight affected villages resulted in 76% coverage of the targeted population.@*Discussion@#Low routine coverage and measles occurrence among unvaccinated individuals indicate underimmunized areas. The geographical and sociodemographic characteristics of this outbreak highlight the need for tailored vaccination strategies to close the immunity gap. A sensitive surveillance system that is able to detect, notify, investigate and guide response measures, including a second measles dose in the routine immunization schedule, will be essential for the Lao People’s Democratic Republic to attain its measles elimination status.
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Objective: Evidence from developing countries on the association between women’s endorsement of attitudes justifying partner abuse and their use of reproductive health services is suggestive but inconclusive. This study uses a nationally representative dataset from Lao PDR to provide strong evidence for the relationship between women’s endorsement of attitudes justifying partner abuse and use of reproductive health services.Methods: This study used data from the 2011–2012 Lao Social Indicator survey (LSIS). The analyses were performed on the responses of 4227 women. The exposure of interest in this study was endorsement of attitudes justifying partner abuse. Antenatal care (ANC) visits divided according to amount and quality, delivery care by type and place, and utilization of postnatal care (PNC) for mothers and newborn infants were used as representative outcome variables of reproductive health service utilization.Results: Approximately seven out of ten respondents (67.9%) believed that partner abuse was justified. Women who endorsed these attitudes were significantly less likely to receive any ANC, to seek institutional delivery, and to use trained medical personnel for delivery assistance. Endorsing attitudes were associated with reduced probability of receiving PNC services for mothers and newborn infants, reduced frequency of ANC visits, and receiving a fewer number of ANC components. Other sociodemographic factors likely to affect the increased utilization of several of the indicators of reproductive health care were living in the central region, belonging to the high bands of wealth, having higher level of education, being a young adult (20–34 years) or older (35–49 years), residing in urban areas, and being sexually empowered.Conclusions: In addition to a broad range of sociodemographic factors, our findings suggested that women’s endorsement of attitudes justifying partner abuse should be treated as an important psychosocial determinant of reproductive health care service utilization in Lao PDR.
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Adult specimens of Echinostoma ilocanum (Garrison, 1908) Odhner, 1911 (Trematoda: Echinostomatidae) were recovered from 2 riparian people who resided along the Mekong River in Savannakhet Province, Lao PDR. In fecal examinations done by the Kato-Katz technique, they revealed echinostome eggs together with eggs of Opisthorchis viverrini (and minute intestinal fluke eggs) and hookworms. To recover the adult flukes, they were treated with praziquantel 30–40 mg/kg in a single dose and purged with magnesium salts. A total of 658 adult fluke specimens were recovered from the 2 people; 456 from case 1 and 202 from case 2. Specimens from case 1 consisted of 335 echinostomes (301 E. ilocanum and 34 species undetermined), 120 O. viverrini, and 1 Haplorchis taichui, and those from case 2 consisted of 36 E. ilocanum, 134 O. viverrini, and 32 H. taichui. Thus, the number of E. ilocanum specimens was 337 in total (average per person, 168.5). From this study, it is suggested that foodborne intestinal flukes and liver flukes are highly prevalent along the Mekong River in Savannakhet Province. The present report describes for the first time human infections with E. ilocanum in Lao PDR.
Subject(s)
Adult , Humans , Ancylostomatoidea , Echinostoma , Echinostomiasis , Eggs , Fasciola hepatica , Magnesium , Opisthorchis , Ovum , Praziquantel , Rivers , Salts , TrematodaABSTRACT
PURPOSE: The purpose of this study was to evaluate the food insecurity status and dietary behavior and examine the association between the food insecurity status and consumption of processed beverage for secondary school students in Vientiane, capital city of Lao PDR. METHODS: The study subjects are 714 students (boys = 307 and girls = 407) in four secondary schools (Chao_Anouvong, Phiavat, Saysetha, and Chansavang) of Vientiane, Lao PDR. Data on study subject's demographic characteristics, dietary behavior, food insecurity, and Mini Dietary Assessment (MDA) index were collected. A “Self-Administered Food Security Survey Module for Children Aged 12 Years and Older” developed by the United States Department of Agriculture (USDA) was used for the food insecurity assessment. RESULTS: As a result, 72.7% of the subjects were in a state of food insecurity, and food security was associated with higher socioeconomic status (higher life satisfaction, higher parent's education attainment, higher item ownership, fewer number of siblings, and having more lunches at the school restaurant than at home). Compared to the food insecurity group, the frequency of breakfast, self-rated diet, and the total score of MDA index were higher in the food security group. On the other hand, multiple logistic regression analysis showed that ‘food security’ was also associated with a higher consumption of processed beverages (OR 1.544; 95% CI 1.078–2.213; p = 0.018). CONCLUSION: Improving the quality of the diet is essential for adolescents in both the food insecurity and food security groups in Lao PDR. Therefore, it is necessary to provide well organized nutrition education and establish adequate nutrition policy for adolescents in Lao PDR.