UXO Risk Education Needs Assessment

As a result of intense ground battles and extensive bombing during the Indo-China War, especially during the years 1964 – 1973, Lao PDR has the distinction of being, per capita, the most heavily bombed nation in the world. The war left widespread unexploded ordnance (UXO) contamination, which thirty years on continues to act as a barrier to socio economic development causing death and injury to adults and children. UXO injury, especially in a country such as Lao PDR where access to adequate health services is limited, can result in long-term medical and psychological sequelae (Handicap International, 2004) as well as a huge financial burden to affected individuals, families, their communities and health services.Often, those who suffer a landmine/UXO injury are aware of the risk (International Campaign to Ban Landmines, 2000; Geneva International Centre for Humanitarian Demining, 2003). In the Lao PDR as a response to the continuing UXO threat, the Government, with assistance from the United Nations Development Programme (UNDP) and UNICEF established the Lao PDR Trust Fund for UXO in 1995 to finance a national programme of clearance and education. In common with most other mine action programmes, the Lao national UXO programme (1996-ongoing), aims to reduce risk through survey, marking, surface and sub-surface landmine/UXO clearance and mine risk education (MRE). MRE aims to promote safety in UXO contaminated communities and in the Lao PDR has been primarily underpinned by psychological theories of behaviour change, such as the Health Belief Model (Rosenstock1974). More specifically, UNICEF has supported MRE for children in several at risk communities in 12 of the most heavily contaminated provinces. Since 2002, this support was concentrated on implementation of two projects: the introduction of UXO awareness as an extra curricular activity within the primary school system, implemented by World Education Consortium with the Ministry of Education and ‘Sport in the Box\u27 safe play activities implemented by the Lao Youth Union (LYU). Since the outset, UNICEF has supported continuous monitoring and evaluation, including UNICEF funded evaluations in 2000 (Delneuville, A.) and 2005 (GICHD). In 2001 UXO LAO also undertook a Knowledge, Attitude and Practice (KAP) study in 3 provinces followed by a more in depth qualitative study in one province to try and understand the contributing factors to UXO risk behaviour and injury (UXO LAO, Sisawath, B and Durham, J. 2001 and Sisawath,B. and Durham, J. 2002). In 2005 UNICEF also commissioned a study into the Scrap Metal Trade in the Lao PDR (GICHD, 2005). An evaluation of UNICEF MRE activities was also commissioned by UNICEF in 2005 and recommended that in preparation for the next 5 year strategy, a MRE assessment be undertaken to ascertain who is currently at risk, why and what can be done to mitigate the risk. As a result of the evaluation recommendations, this assessment aims to answer these questions. More specifically the main objectives of the assessment were:1. To collect and analyse quantitative and qualitative data to identify who is at risk of UXO accidents, why and what can be done about it2. To involve a range of stakeholders in the assessment3. To provide a report based on the above which can be used to underpin the MRE strategy for the Lao PDR and for UNICEF specifically and can be used to develop measurable impact and outcome objectives and indicators4. To provide recommendations on appropriate UXO messages and risk reduction strategie

Concurrent multiple health risk behaviors among adolescents in Luangnamtha province, Lao PDR

<p>Abstract</p> <p>Background</p> <p>Multiple health risk behaviors (HRBs) among adolescents pose a threat to their health, including HIV/AIDS. Health risk behaviors such as alcohol use, smoking, substance use, and sexual risk behaviors among youth have been shown to co-occur with each others. The objectives of this study was to estimate the prevalence of single and concurrent health risk behaviors and to explore how health risk behavior is associated with socio-demographic factors and peers' behaviors.</p> <p>Methods</p> <p>A cross sectional design was used to examine health risk behaviors of adolescents between the age 14 and 19 years living in the Luangnamtha province, Lao PDR. The study was conducted between June and August, 2008. An ordinal logistic regression model that simultaneously explored demographic factors and the influence of the behavior of peers on three categories of multiple HRBs (no risk, one risk, and two or more health risk behaviors) was performed.</p> <p>Results</p> <p>A total of 1360 respondents, 669 (49.1%) boys with mean age 16.7 ± 1.6 and 699 (50.9%) girls aged 16.1 ± 1.5 were recruited into the study. The majority reported two or fewer risk behaviors. However, multiple risk behaviors increased with age for both sexes. About 46.8% (n = 637) reported no risk, 39.3 percent (n = 535) reported one risk, 8.1 percent (n = 110) reported two risks, and 5.8 percent reported more than two health risk behaviors.</p> <p>The protective factors among boys were school attendance (OR = .53, CI = .33-.86), being Hmong and Yao ethnicity (OR = .48, CI-.26-.90), while being above the age of 15 (OR = 2.20, 95% CI = 1.33-3.60), Akha ethnicity (OR = 2.20, 95% CI = 1.04-4.61), peer's smoking (OR = 3.11, 95% CI = 2.1-4.6), and peer's drinking alcohol (OR = 1.88, 95% CI = 1.1-3.21) were significantly associated with the presence of multiple risk behaviors among boys.</p> <p>Having some education (OR = 0.17, 95% CI = 0.06-0.45), and being of Hmong and Yao ethnicity (OR = 0.38, 95% CI = 0.18-0.80) were factors that protected girls from multiple risk behaviors; while peer's drinking alcohol (OR = 2.55, 95% CI = 1.59-4.09) and peer's being sexually active (OR = 2.82, 95% CI = 1.65-4.8) were significantly associated with the presence of multiple risk behaviors among girls.</p> <p>Conclusion</p> <p>There are sex, age and ethnic differences in the concurrent health risk behaviors. The influencing factors are adolescent's education and peer influence. Interventions should focus to encourage adolescents to complete the compulsory primary education as well as help them to establish friendships and follow peers with good behavior. Risk reduction messages need to take account of diverse multiple HRBs within the specific socio-cultural and gender specific context and target vulnerable adolescents such as ethnic minorities and less educated adolescents.</p