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BackgroundThe COVID-19 pandemic is expected to exacerbate food insecurity in low- and middle-income countries, through loss of income and disrupted food supply chains. Lao PDR has among the highest rates of malnutrition in Southeast Asia. We assessed the relative difficulty in meeting food needs during the COVID-19 pandemic in rural districts of Luang Prabang Province, Lao PDR compared to before; determined associations between pandemic-associated difficulties in food access and household, maternal and child food security; and identified resiliency-promoting strategies. MethodsIn November 2020, households (N = 1,122) with children under five years were interviewed. Respondents reported the relative ease of access of food and health care as well as changes in income and expenditures compared to before March 2020. We used generalized linear models with cluster robust standard errors to assess univariate and multivariate associations. ResultsNearly four-fifths (78.5%) found it harder to meet household food needs during the pandemic. The most common reasons were increased food prices (51.2%), loss of income (45.3%), and decreased food availability (36.6%). Adjusting for demographics, households with increased difficulty meeting food needs had lower food consumption scores and child dietary diversity. Over 85% of households lost income during the pandemic. Decreased expenditures was associated with reliance on more extreme coping strategies to meet food needs. The households who experienced no change in meeting food needs produced a greater percentage of their food from homegrown methods (4.22% more, 95% CI: 1.28, 7.15), than households who found it more difficult. We estimated that decreases in child bodyweight by 0.5 - 1% would increase wasting in this population by 1.7 - 2.1 percentage points. ConclusionsPandemic-associated shocks may have large effects on malnutrition prevalence. Action is needed to mitigate consequences of the pandemic on nutrition. Local food production and safety net programs that offset income losses may help. Summary BoxO_ST_ABSWhat is already known?C_ST_ABSThe COVID-19 pandemic has disrupted food supply chains and livelihoods, causing concerns that a global nutrition crisis is imminent and prompting leaders from United Nations agencies to issue an immediate call to action to direct funds towards prevention of child malnutrition. While documented COVID-19 transmission in Lao PDR was lower than that of surrounding counties, malnutrition rates are high, particularly in the northern province of Luang Prabang, which is heavily reliant on tourism for livelihoods. What are the new findings?Nearly four-fifths of those interviewed in Luang Prabang Province, Lao PDR reported that it was harder to meet their households food needs, compared to before the pandemic, with 51% attributing the reason to increased food prices. Over 85% of households reported losing income. Lower expenditures and increased difficulty obtaining food were both associated with lower household food consumption scores and higher household coping strategies, in adjusted analyses. Households who obtained a greater proportion of their foods through home production appeared more resilient than households who obtained a greater proportion of their foods through purchasing. What do the new findings imply?The pandemic may deeply exacerbate food insecurity in Lao PDR, potentially leading to increases in child wasting. Increased local food production and establishment of safety net programs that offset income losses may be two strategies that address this problem among this population.
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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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Background@#There is a high prevalence of HBsAg in adults in Lao PDR, as seen in first-time blood donors. The high positive rate is also detected in repeat donors although the cause is unclear. By surveying blood donors, this study examines the general population’s knowledge level of HBV infection and assesses the public’s perception of vaccination.@*Objective@#The aims of this study were to assess knowledge, attitude and practices (KAP) of blood donors regarding HBV infection. @*Methodology@#We conducted a cross-sectional study to collect the KAP information among consenting students of high school and university in March-September, 2018. A self-answered questionnaire was also utilized among blood donors in Vientiane Capital, Luang Prabang and Khammuan Provinces. The questionnaires were distributed and completed in the classroom setting with investigators proctoring. Descriptive analysis was performed on the socio-demographic characteristics, Student’s T-test were performed to examine the difference of mean and linear regression models the association between dependent and independent variables. @*Results@#Among 625 blood donors (132 health science students and 477 non-health science students), all had a positive attitude towards blood donation, but they had low knowledge towards hepatitis infection and prevention. Multivariable analysis showed that x factors were significantly associated with HBV vaccination. This included gender, level of education, being a health science student, HBV positivity status and awareness not to donate blood and knowledge towards vaccination. HBV vaccination hesitation was observed in blood donors who did not know that vaccination can prevent infection, and most blood donors (76.9%) answered that they were healthy so did not see the need for the vaccine and did not understand this vaccination method as prevention. A fear of injections, belief that they would not be able to drink alcohol for two weeks surrounding vaccination and that it was not necessary to prevent HBV infection were reasons given to not seek HBV vaccination.@*Conclusion@#Blood donors had overall poor knowledge on hepatitis B infection and prevention, particularly among the non-health student donors. Blood donors should be aware of and understand their HBsAg testing status and broaden their perception and knowledge on HBV infection and prevention.
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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. @*Objective@#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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@#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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Rational and Background: Pregnant women are more likely to be at risk of oral disease compared to those who are not pregnant. Oral disease during pregnancy affects not only maternal but also child health. Very little is known about the oral health problems among Lao pregnant women. Methodology: In this descriptive, cross-¬sectional study we described the oral health problems and identified factors related to the oral diseases among Lao women with > 12 weeks of pregnancy who visited the two central hospitals (Mother and Child Health and Mahosot) in Vientiane, Laos between January and February 2010. Oral health was checked by a dentist and an interview was conducted with pregnant women using pre¬designed questionnaires. Data were analyzed using STATA 8.0 and logistic regression was applied to determine factors associated with oral diseases. Results: Five hundred pregnant women aged between 15 and 42 years [Mean (SD) = 26.7 (5.0)] were studied. The proportion of oral disease was 64.6% [dental carries (43%), gingivitis (8.4%), and both carries + gingivitis (13.2%)]. Half of the pregnant women (52.8%) had poor oral health care (brush teeth 2,000,000 LAK/month [OR = 1.8, 95%CI = 1.0 ¬3.0, P = 0.04], teeth brushing 2 pregnancies in their lives [OR = 2.6, 95%CI = 6.0 ¬10.0, P 2 deliveries in their lives [OR = 5.4, 95%CI = 1.2 ¬2.1, P < 0.001], and those with history of oral disease before pregnancy [OR = 2.5, 95%CI = 1.7 ¬3.8, P < 0.001]. Conclusion: This study showed that more than half of Lao pregnant women had oral disease and their oral health self¬-care behavior was low. Poor oral health self-¬care behavior, multiple pregnancies and deliveries, and history of oral disease before pregnancy were factors significantly related with oral disease during pregnancy. Health education on oral health self¬-care and oral health check during ante¬natal clinic visits by the pregnant women should be provided and urgently implemented.
