Areas Of Lao PDR Research Articles

Dry Swabs and Dried Saliva as Alternative Samples for SARS-CoV-2 Detection in Remote Areas in Lao PDR.

Surveillance of SARS-CoV-2 circulation is mainly based on real-time reverse transcription-polymerase chain reaction, which requires laboratory facilities and cold chain for sample transportation. This is difficult to achieve in remote rural areas of resource-limited settings. The use of dried blood spots shipped at room temperature has shown good efficiency for the detection of arboviral RNA. Using a similar approach, we conducted a study at 3 provincial hospitals in Laos to compare the detection of SARS-CoV-2 from neat and dried spot samples. Between January 2022 and March 2023, patients with respiratory symptoms were recruited. Nasopharyngeal/oropharyngeal swabs in virus transport medium (VTM), dry swabs, saliva, and dried saliva spotted on filter paper were collected. All samples were tested by SARS-CoV-2 real-time reverse transcription-polymerase chain reaction. In total, 479 participants were included. The VTM samples tested positive for 288 (60.1%). High positive percent agreements were observed for dry swab (84.8%; 95% CI, 80.2%-88.8%) and saliva (89.2%; 95% CI, 85.1%-92.6%) as compared with VTM. There was a loss of sensitivity when saliva was dried on filter paper (73.6%; 95% CI, 68.1%-78.6%) as compared with saliva. SARS-CoV-2 variant (Delta or Omicron) had no significant impact on the performance of the different sample types. Our findings suggest that dry swabs could be a good alternative for sample collection and permit easy shipping at ambient temperature for subsequent viral SARS-CoV-2 RNA purification and molecular investigation. This is a useful tool to consider for a rapid implementation of large-scale surveillance of SARS-CoV-2 in remote areas, which could be extrapolated to other respiratory targets during routine surveillance or in the case of a novel emerging pandemic.

Diversity of Beetle Family Curculionidae and Bostrichidae (Coleoptera) in Two National Protected Areas in Lao PDR

Diversity of Beetle Family Curculionidae and Bostrichidae (Coleoptera) in Two National Protected Areas in Lao PDR

Exploring men’s involvement in family planning in Lao PDR

ABSTRACT This study explores men’s involvement in family planning programmes in a rural area of Lao PDR. Data from interviews with ethnic minority Mangkong couples and women suggest that while there are some positive outcomes from men’s involvement in family planning, such as increased spousal communication and shared responsibility for housework and childcaring, the current family planning model still places the burden on women as the main contraceptive users. This results in the exclusion of men from obtaining family planning information and services. Recommendations are provided for creating family planning programmes that are context-specific and gender-equitable.

Availability, affordability, and quality of essential antiepileptic drugs in Lao PDR.

ObjectiveEpilepsy is a chronic condition treatable by cost‐effective antiepileptic drugs (AEDs), but limited access to treatment was documented. The availability and affordability of good quality of AEDs play a significant role in access to good health care. This study aimed to assess the availability, affordability, and quality of long‐term AEDs in Lao PDR.MethodA cross‐sectional study was performed in both public and private drug supply chains in urban and rural areas in Lao PDR. Data on AEDs availability and price were obtained through drug suppliers. Affordability was estimated as the number of day wages the lowest‐paid government employee must work to purchase a monthly treatment. Samples of AEDs were collected, and the quality of AEDs was assessed through Medicine Quality Assessment Reporting Guidelines.ResultsOut of 237 outlets visited, only 50 outlets (21.1% [95% CI 16.1‐26.8]) had at least one AED available. The availability was significantly different between urban (24.9%) and rural areas (10.0%), P = .017. Phenobarbital 100 mg was the most available (14.3%); followed by sodium valproate 200 mg (9.7%), phenytoin 100 mg (9.7%), and carbamazepine 200 mg (8.9%). In provincial/district hospitals and health centers, AEDs were provided free of charge. In other healthcare facilities, phenytoin 100 mg and phenobarbital 100 mg showed the best affordability (1.0 and 1.2 day wages, respectively) compared to carbamazepine 200 mg (2.3 days) and other AEDs. No sample was identified as counterfeit, but 15.0% [95% CI 7.1‐26.6] of samples were classified as of poor quality.SignificanceWe quantified and qualified the various factors contributing to the high treatment gap in Lao PDR, adding to diagnostic issues (not assessed here). Availability remains very low and phenobarbital which is the most available and affordable AED was the worst in terms of quality. A drug policy addressing epilepsy treatment gap would reduce these barriers.

Correlations among Tree Quality, Stand Characteristics, and Site Characteristics in Plantation Teak in Mountainous Areas of Lao PDR

Teak (Tectona grandis Linn. f) is a globally valuable hardwood tree species whose growth performance and tree quality characteristics are controlled by various factors. Teak tree quality characteristics such as stem straightness, buttressing, and protuberant buds/knots are important in the sawing process, and directly affect timber yield, timber grade, recovery, and cost. In this study, we assessed the relationships among tree quality characteristics, stand characteristics, and site characteristics in plantation teak in the Luang Prabang province of the Lao PDR. We established 53 sample plots (20 × 20 m) and measured a total of 2149 sample trees. The stand-level tree age ranged from 10 to 31 years, and the trees were distributed in various modes of topography. The altitude ranged from 287 to 867 masl. The results of Spearman’s partial rank correlation analysis among the parameters revealed the present condition of the teak plantation forest in the region. The altitude was related to stand age and was correlated with tree quality characteristics such as epicormic shoots, mode of branching, and branch size. The correlation results suggest that higher-density plantation at the higher altitude sites might be suitable for teak plantations in this area. In addition, we found that a longer rotation in forest management might degrade tree quality.

Aedes mosquito surveillance and the use of a larvicide for vector control in a rural area of the Lao People\u2019s Democratic Republic

BackgroundRefillable water containers are commonly used in rural areas of Lao PDR, and they act as Aedes mosquito breeding sites. Aedes aegypti and Ae. albopictus mosquitos are transmission vectors for the dengue virus, which causes dengue fever.MethodsTwo isolated rural villages in the central part of Lao PDR were selected as study sites. In the intervention village, domestic water containers were continuously treated with a long-lasting matrix release formulation, containing pyriproxyfen, named SumiLarv®2MR. In the control village, entomological activity was monitored, but no intervention was performed. Baseline data were collected in both villages during the late rainy season (October 2017) then distributed SumiLarv®2MR disks in intervention village. This data was compared with data collected during the intervention periods in the dry season (February 2018), rainy season (July 2018 and 2019), and late rainy season (September 2018) in the region.ResultsCompared with the baseline data (20.24%), the percentage of water containers infested with Ae. aegypti larvae was significantly decreased in the treated village, especially in the rainy seasons in July 2018 (4.11%; P < 0.001) and July 2019 (2.46%; P < 0.001), while the percentage of water containers infested with Ae. albopictus larvae did not decrease significantly in prevalence. No reduction in the frequency of Aedes species was seen in the control village. The Ae. albopictus liked to breed in small habitats (the median water volume of its habitats was 5 L and 10 L in the control and treated village, respectively, while the equivalent values for Ae. aegypti were 30 L and 50 L, respectively).ConclusionThe treatment of refillable water storage containers in a rural village with SumiLarv®2MR disks led to significant reductions in the Ae. aegypti population. However, the Ae. albopictus population did not decrease in either the control or treated village. This discrepancy was due to differences in habitat-seeking behaviors and preferred breeding sites such as types of water, water container, and water volume, then led to the differences in results of mosquito prevalence after SumiLarv®2MR disk treatments. The SumiLarv®2MR disk treatment was proven to be effective against the primary dengue-virus vector mosquitoes, Ae. aegypti.

Electrical power system restoration planning in southern area of Lao PDR

Electrical power system restoration planning in southern area of Lao PDR

Valuing biodiversity protection: Payment for Environmental Services schemes in Lao PDR

AbstractThe design of a Payment for Environmental Services (PES) scheme that involves setting a ‘pseudo market price’ per unit of environmental service requires the estimation of demand and supply. This paper presents the results of discrete choice experiments aimed at estimating the demand for environmental and social services generated by a wildlife protection PES scheme in two protected areas in Lao PDR. The discrete choice experiments targeted international tourists sampled at Vientiane airport and the urban Lao population sampled in Vientiane City as potential buyers of the environmental and social services provided by the PES scheme. The survey was customised to a developing country context to address diversity in respondents' literacy levels, language limitations of the interviewers, socio-cultural conventions, and limited trust in confidentiality and anonymity of the survey process. The marginal benefits of the environmental services so estimated were used to inform the development of a PES scheme.

Costing biodiversity protection: payments for environmental services schemes in Lao PDR

ABSTRACTA Payments for Environmental Services (PES) scheme that involves setting a ‘pseudo market price’ requires the estimation of demand and supply. This paper presents the estimated marginal costs of anti-poaching patrols designed to enhance biodiversity in two protected areas in Lao PDR. This supply information was used in conjunction with environmental production functions and estimated demand for biodiversity to determine the ‘price’ paid per patrol. Marginal costs were estimated through uniform-price conservation actions: Teams of local people interested in being part of the PES scheme bid for the number of patrols they would like to provide in response to a range of offered prices. The auction process generated a sequence of well-behaved price-quantity pairs that track the individual marginal cost function of each bidding team accounting for both fixed and variable costs. The marginal costs vary across bidders. These variations can be explained by differences in competing employment and income opportunities across bidders, village locations and seasons. The results provide evidence of heterogeneous opportunity costs of supply and suggest an efficiency loss in assuming homogeneity.

Comparison of novel and standard diagnostic tools for the detection of Schistosoma mekongi infection in Lao People\u2019s Democratic Republic and Cambodia

BackgroundGiven the restricted distribution of Schistosoma mekongi in one province in Lao People’s Democratic Republic (Lao PDR) and two provinces in Cambodia, together with progress of the national control programmes aimed at reducing morbidity and infection prevalence, the elimination of schistosomiasis mekongi seems feasible. However, sensitive diagnostic tools will be required to determine whether elimination has been achieved. We compared several standard and novel diagnostic tools in S. mekongi-endemic areas.MethodsThe prevalence and infection intensity of S. mekongi were evaluated in 377 study participants from four villages in the endemic areas in Lao PDR and Cambodia using Kato-Katz stool examination, antibody detection based on an enzyme-linked immunosorbent assay (ELISA) and schistosome circulating antigen detection by lateral-flow tests. Two highly sensitive test systems for the detection of cathodic and anodic circulating antigens (CCA, CAA) in urine and serum were utilized.ResultsStool microscopy revealed an overall prevalence of S. mekongi of 6.4% (one case in Cambodia and 23 cases in Lao PDR), while that of Opisthorchis viverrini, hookworm, Trichuris trichiura, Ascaris lumbricoides and Taenia spp. were 50.4%, 28.1%, 3.5%, 0.3% and 1.9%, respectively. In the urine samples, the tests for CCA and CAA detected S. mekongi infections in 21.0% and 38.7% of the study participants, respectively. In the serum samples, the CAA assay revealed a prevalence of 32.4%, while a combination of the CAA assay in serum and in urine revealed a prevalence of 43.2%. There was a difference between the two study locations with a higher prevalence reached in the samples from Lao PDR.ConclusionsThe CCA, CAA and ELISA results showed substantially higher prevalence estimates for S. mekongi compared to Kato-Katz thick smears. Active schistosomiasis mekongi in Lao PDR and Cambodia might thus have been considerably underestimated previously. Hence, sustained control efforts are still needed to break transmission of S. mekongi. The pivotal role of highly sensitive diagnostic assays in areas targeting elimination cannot be overemphasised.

Comparison of dietary behavior, changes of diet, and food intake between 40~59 years old subjects living in urban and rural areas in Lao PDR

Purpose: The current study was conducted for evaluation and comparison of dietary behavior and food intake in different regions of Lao PDR. Methods: The survey was conducted on 979 people aged 40~59 years old living in 25 urban provinces and 25 rural provinces in four districts (VTE Capital-Chanthabuly, Xaysetha, VTE Province-Phonhong, and Thoulakhom) of Laos. General demographic information, health status, and dietary behavior were surveyed using a questionnaire. Results: The literacy ratio (p = 0.000), education level (p = 0.000), asset ownership level (p = 0.000), and government and private employee ratio (p = 0.000) were higher in urban subjects compared with rural subjects. The mean value of weight (p = 0.000), waist circumference (p = 0.000), and diastolic blood pressure (p = 0.009) and alcohol consumption (p = 0.000), self-rated health status (p = 0.001), and the rate of obesity (p = 0.000) were significantly higher in urban subjects compared with rural subjects. However, the rate of current smoker was significantly higher in the rural group (p = 0.023). Meals are becoming more westernized by higher frequency of eating out, consumption of fatty meat and fried or stir-fried food in urban areas compared to rural areas. Urban subjects had relatively better balanced meals compared to rural subjects whereas they consumed insufficient meals per day and consumed meals irregularly compared to rural subjects. Intake of fruit and milk was significantly higher in urban subjects compared with rural subjects. However, the intake of vegetables was significantly higher in rural areas than urban areas. Conclusion: The result of this study showed that the traditional Lao diet is being replaced by an unhealthy western dietary pattern, which may be a risk factor for increasing development of non-communicable disease (NCD) in Lao PDR. Planning of proper personalized nutritional intervention and education in each area is needed to decrease the health risks of NCD.

Prevalence of Helminthic Infections among Inhabitants of Lao PDR

The prevalence of helminthic infections was surveyed on a total of 6,178 residents (males 2,549 and females 3,629) in 102 villages of 9 provinces in Lao PDR between 2007 and 2011 under the project of Korea-Laos Collaborative Project for Control of Foodborne Trematode Infections in Lao PDR. Fecal specimens were collected and examined by the Kato-Katz thick smear and Stoll's egg counting techniques. The overall liver/intestinal helminth egg positive rate was 71.9% with a single or mixed infections with Opisthorchis viverrini and minute intestinal flukes (Ov/MIF), Ascaris lumbricoides, hookworms, Trichuris trichiura, Trichostrongylus sp., echinostomes, Taenia spp., and others. Ov/MIF revealed the highest prevalence (55.6%) followed by hookworms (27.8%) and T. trichiura (6.5%). The endemic regions with the highest prevalence of Ov/MIF were Savannakhet, Khammouane, Vientiane (Nam Ngum), Champasak (Khong Island), and Saravane Province. High prevalences of A. lumbricoides (33.8%), hookworms (47.8%), and T. trichiura (32.6%) were observed in Phongsaly, Luang Prabang, and Vientiane (Nam Ngum) areas, respectively. The results of this study highlight helminth parasites of current public health significance in different areas of Lao PDR.

Changes in pregnancy and childbirth practices in remote areas in Lao PDR within two generations of women: implications for maternity services

This paper sheds light on the inter-generational changes in pregnancy and childbirth practices in remote areas of Lao PDR over a period of 30 years. The study consisted of focus group discussions with pregnant women aged 14–30, mothers and fathers of small children, and older women aged 40+ in six rural communities in two districts. Childbirth practices were gradually evolving and changing – most dramatically illustrated by the transition from forest-based to home-based delivery, and a few health facility-based deliveries when complications occurred. Today’s generation of women aged 40+ did not recommend all the practices of their mothers, but saw the need to adapt due to the social and medical risks they had experienced, especially high rates of neonatal death. Their daughters are doing the same. The increase in home-based deliveries should be regarded as significant progress in this setting in rural Laos. Understanding how young women interpret their options and incorporating that knowledge and the experience of successful local outreach programmes into health system policy and practice for maternity care, e.g. by strengthening the skills of community-based health workers, could contribute to improving maternal and neonatal survival and reducing health inequalities.

Efficacy of Praziquantel against Schistosoma mekongi and Opisthorchis viverrini: A Randomized, Single-Blinded Dose-Comparison Trial

BackgroundSchistosomiasis and opisthorchiasis are of public health importance in Southeast Asia. Praziquantel (PZQ) is the drug of choice for morbidity control but few dose comparisons have been made.MethodologyNinety-three schoolchildren were enrolled in an area of Lao PDR where Schistosoma mekongi and Opisthorchis viverrini coexist for a PZQ dose-comparison trial. Prevalence and intensity of infections were determined by a rigorous diagnostic effort (3 stool specimens, each examined with triplicate Kato-Katz) before and 28–30 days after treatment. Ninety children with full baseline data were randomized to receive PZQ: the 40 mg/kg standard single dose (n = 45) or a 75 mg/kg total dose (50 mg/kg+25 mg/kg, 4 hours apart; n = 45). Adverse events were assessed at 3 and 24 hours posttreatment.Principal FindingsBaseline infection prevalence of S. mekongi and O. viverrini were 87.8% and 98.9%, respectively. S. mekongi cure rates were 75.0% (95% confidence interval (CI): 56.6–88.5%) and 80.8% (95% CI: 60.6–93.4%) for 40 mg/kg and 75 mg/kg PZQ, respectively (P = 0.60). O. viverrini cure rates were significantly different at 71.4% (95% CI: 53.4–84.4%) and 96.6% (95% CI: not defined), respectively (P = 0.009). Egg reduction rates (ERRs) against O. viverrini were very high for both doses (>99%), but slightly lower for S. mekongi at 40 mg/kg (96.4% vs. 98.1%) and not influenced by increasing diagnostic effort. O. viverrini cure rates would have been overestimated and no statistical difference between doses found if efficacy was based on a minimum sampling effort (single Kato-Katz before and after treatment). Adverse events were common (96%), mainly mild with no significant differences between the two treatment groups.Conclusions/SignificanceCure rate from the 75 mg/kg PZQ dose was more efficacious than 40 mg/kg against O. viverrini but not against S. mekongi infections, while ERRs were similar for both doses.Trial RegistrationControlled-Trials.com ISRCTN57714676

Factors Associated with Antenatal Care Utilization Among Rural Women in Lao People’s Democratic Republic

This study aims at exploring factors related to the antenatal care (ANC) utilization in rural areas of Lao PDR. A quantitative, cross-sectional interview study was conducted in the Khammouane and Champasack provinces. The study population comprised all currently pregnant women 15-45 years of age with a gestational period beyond 32 weeks plus all women who had given birth during the last 12 months. With the informed consent of all eligible women, 460 respondents were included in the study and interviewed using a structured questionnaire. Multiple logistic regression analysis was applied to determine factors significantly related to ANC use. Fifty-one percent of the respondents had at least one ANC visit. Among the users, 63% had visited ANC three times or more but only 28% attended during the first trimester. After adjusting for other factors, using a 95% Confidence Interval (CI), statistically significant associations were found between ANC use and the following factors: women whose husbands were salaried employees (OR=2.66, CI=1.45-4.88); women younger than 18 years old at first pregnancy (OR 0.56, CI=0.28-0.97); women perceiving ANC as somewhat useful (OR=2.88, CI=1.26-6.61) or very useful (OR=7.45, CI=3.59-15.46). Awareness of the usefulness of ANC was related to more frequent use and could be one focus of community intervention to increase utilization.

Health promoting schools in urban, semi-urban and rural Lao PDR

Health promoting school activities have been implemented in developing countries, but their experiences have not been fully shared. Our objective is to explore the differences of health promoting school status in urban, semi-urban and rural areas in Lao PDR. To accomplish this we evaluated 138 schools in three provinces using a checklist developed by the government school health taskforce. We interviewed first through fifth grade pupils, school principals, food vendors, community chiefs, and observed school environments. We found that urban and semi-urban schools had higher scores than rural schools in the areas of, "personal health and life skills," "healthy school environment," "health and nutrition services," and "common disease control and prevention." However, semi-urban and rural schools showed better results than urban schools for some questions within the "school and community partnerships" component. When the results of individual schools were examined, there was considerable variation. We found a tendency for higher scores in urban areas, which went down for semi-urban areas and further decreased for rural areas. However, we also found differences among schools within each study site. In conclusion, we found not only a large difference among urban, semi-urban and rural schools but also clear differences in health promoting school status among schools within each study site in Lao PDR. Based on the results, we recommend that each school adopt a tailored approach for the health promoting school programme based upon an analysis of its own scores.

Seroprevalence of Leptospirosis and Risk Factor Analysis in Flood-prone Rural Areas in Lao PDR

A cross-sectional seroprevalence study on leptospirosis, using microscopic agglutination test (MAT), was conducted in rural villages in Khammouane Province, Lao People's Democratic Republic, in December 2006. The overall prevalence of leptospiral infection among 406 subjects was 23.9% (95% confidence interval [CI] 19.7-28.0%). Independent risk factors for the infection, identified by multivariate logistic regression, were male sex (odds ratio [OR], 1.92; 95% CI: 1.24-2.98), recent flooding on one's own property (OR, 2.12; 95% CI: 1.25-3.58), and collecting wood in the forest (OR, 1.90; 95% CI: 1.17-3.09). Age, occupation, and animal ownership were not associated with seropositivity. Flooding was associated with the risk of infection particularly for women, whose behaviors or activities involving contact with floodwater were presumed to play an important role. This study showed that leptospirosis is endemic in Khammouane Province and that local flooding plays an important role in the transmission of the disease.

Setting Priorities for Teaching and Learning: An Innovative Needs Assessment for a New Family Medicine Program in Lao PDR

Lao People's Democratic Republic (Lao PDR) is a small, tropical, landlocked country in southeast Asia. It is one of the least developed countries in the region, and its socioeconomic indicators are among the lowest 25% in the world. The World Health Organization has long called for increased equity in primary health care access around the world. To meet this need in Lao PDR, the Family Medicine Specialist Program was developed, a Lao-generated postgraduate training program designed to produce community-oriented primary care practitioners to serve the rural, remote areas of Lao PDR, where 80% of the population lives. An innovative method of needs assessment was required to determine the health care priorities to be met by this new program. Through the use of a modified Delphi technique, local key leaders in medical education, clinical specialists, and teachers were consulted to develop prioritized objectives for the hospital-based curriculum of the program. By setting priorities for teaching and learning in the unique and needy circumstances of Lao PDR, a novel approach to curriculum planning in a low-income country was explored and ultimately formed the foundation of the new curriculum. This process served to direct the allocation of scarce resources during implementation of this groundbreaking program. More importantly, this model of needs assessment could potentially be used to customize medical curricula in other low-income countries facing challenges similar to those in Lao PDR.

Women's Work and Market Hierarchies Along the Border of Lao PDR

Contrary to claims by some neo‐liberalists that international borders are becoming irrelevant, market liberalisation can actually enhance the effect that borders have on the lives of the people living along them. This study examines how the opening of border trade between Laos and Thailand has influenced gender divisions of labour, and definition of women's work along the border zone. Studies were undertaken in two border areas in Lao PDR—Sayaboury province and Kammoune province. In the former, cotton‐weaving activities were studied and in the latter, sticky rice box production. The production and trading of these commodities brought crucial cash income to the women studied and their households. How the women benefited from these activities in terms of income and status depends on how other members of the family perceived these activities. However, the formalisation of the border trade has changed women's ‘sense of space’ and their relations with men and other women.