Smoking among Lao medical doctors: challenges and opportunities for tobacco control

BACKGROUND: Smoking is an increasing threat to health in low-income and middle-income countries and doctors are recognised as important role models in anti-smoking campaigns. OBJECTIVES: The study aimed to identify the smoking prevalence of medical doctors in Laos, their tobacco-related knowledge and attitudes, and their involvement in and capacity for tobacco prevention and control efforts. METHODS: This was a cross-sectional national survey by a researcher-administered, face-to-face questionnaire implemented at provincial health facilities throughout the central (including national capital), northern and southern regions of Laos in 2007. Both descriptive and inferential statistics were used. RESULTS: Of the 855 participants surveyed, 9.2% were current smokers and 18.4% were ex-smokers; smoking was least common in the central region (p<0.05) and far more prevalent in males (17.3% vs 0.4%; p<0.001). Smoking was concentrated among older doctors (p <0.001). Over 84% of current smokers wanted to quit, and 74.7% had made a recent serious attempt to do so. Doctors had excellent knowledge and positive attitudes to tobacco control, although smokers were relatively less knowledgeable and positive on some items. While 78% of doctors were engaged in cessation support, just 24% had been trained to do so, and a mere 8.8% considered themselves 'well prepared'. CONCLUSION: The willingness of doctors to take up their tobacco control role and the lower smoking rates among younger respondents offers an important window of opportunity to consolidate their knowledge, attitudes, skills and enthusiasm as cessation advocates and supports

Data verification at health centers and district health offices in Xiengkhouang and Houaphanh Provinces, Lao PDR

Background: Routine health information is an essential health system building block. In low and low-middle income countries however, concerns about the quality of routine administrative data have often undermined their use. The purpose of the present study was to verify the data availability, and consistency of six key maternal and child health indicators (first antenatal care, fourth antenatal care, skilled birth attendants, postnatal care, 'Bacillus Calmette Guerin and diphtheria-pertussis-tetanus third dose)

Stakeholder analysis of community distribution of misoprostol in Lao PDR: A qualitative study

Background Globally, significant progress has been made in reducing maternal mortality, yet in many low-resource contexts it remains unacceptably high. Many of these deaths are due to postpartum haemorrhage and are preventable with access to essential obstetric care. Where there are barriers to access, maternal deaths could be prevented if community-level misoprostol was available. The purpose of this study was to explore perceptions of stakeholders regarding misoprostol use in the Lao People’s Democratic Republic, a setting with high maternal mortality. Methods Semi-structured interviews were conducted with 35 stakeholders in the capital, Vientiane and in one northern province identified as a site for a possible intervention. The sample included international and national stakeholders involved in policy-making and providing maternal and reproductive health services. Findings Most stakeholders supported a pilot program for community distribution of misoprostol but levels of awareness of the drug’s use in preventing postpartum haemorrhage and level of influence over policy direction varied considerably. Some international organizations, all identified as powerful in influencing policy, were ambivalent about the use of community distribution of misoprostol. Concerns related to the capacity of village health workers or lay people to safely administer misoprostol, whether its distribution would undermine efforts to improve access to safe delivery services and active management of the third stage of labour, the ease with which prescription drugs can be bought over the counter, and technical, logistical, and financial constraints. Conclusion Access to appropriate oxytocic drugs is a matter of health equity. In settings without access to essential obstetrical care, misoprostol represents a viable solution for the prevention of postpartum haemorrhage. Understanding stakeholders’ perspectives and their legitimate concerns on misoprostol can inform interventions in order to assuage these concerns and enable disadvantaged women to access misoprostol and its potentially life-saving benefits

Perceptions and management of postpartum haemorrhage among remote communities in Lao PDR

INTRODUCTION: In Lao People's Democratic Republic, despite a policy to provide free maternal health services in healthcare facilities, many rural women continue to deliver at home, without a skilled birth attendant. These women are at high risk of postpartum haemorrhage, the leading cause of maternal mortality in the country. While women in remote areas continue to be unable to access facility-based birthing, interventions to reduce postpartum haemorrhage are a priority. This requires an understanding of how women and their families recognise and manage postpartum haemorrhage in home births. The purpose of this study was to understand community perceptions and management of postpartum bleeding during home births in remote Lao communities. METHODS: Five focus group discussions with a total of 34 women and their support networks were conducted in five remote communities in Oudomxay, a province with high rates of maternal mortality. Villages were selected with district health officials based on (1) known cases of postpartum haemorrhage, (2) travel time from the provincial capital (2-4 hours), (3) distance to the district health service (>4 km), and (4) population (50-150 people), with the five selected villages being the farthest from the district health service. The focus group discussions were complemented by qualitative, community-based key informant interviews (n=9). All interviews were conducted in Lao, English or the ethnic language most suitable for the sample and simultaneously translated by native speakers. All transcripts were translated into English, back translated and checked against interview recordings. The qualitative data were coded into key themes while moving between the data and the coded extracts. Interpretation of the data themes and coding was an ongoing process with codes and themes checked by the research team. RESULTS: Women described postpartum bleeding as a normal, necessary cleansing process. Some women felt it was critical in order to expel 'bad blood' and restore the mother to good health. Participants were able to describe late symptoms of postpartum haemorrhage but did not describe any methods to accurately estimate the amount of blood loss that required intervention. Traditional remedies were the first courses of action, potentially delaying treatment at a healthcare facility. When asked about the acceptability of taking oral medication immediately following home births to prevent postpartum haemorrhage, most women felt it would be acceptable provided it would not stop normal bleeding, and its usage, benefits and side-effects were clearly explained. CONCLUSION: While women continue to home birth in remote communities without skilled birth attendants, an informed understanding of traditional management of postpartum haemorrhage can assist in designing culturally responsive interventions. To support a reduction in morbidity and mortality from postpartum haemorrhage, tailored interventions are needed to raise awareness among women and their families to reduce delays in seeking health care. Women felt it would be acceptable to take oral medication to prevent postpartum haemorrhage. As such, community-based distribution of misoprostol that can be administered by lay people would provide an effective and acceptable prevention strategy. Other strategies should include promoting birthing plans, delivery by skilled birth attendants and early initiation of breastfeeding

Predictors of premarital sexual activity among unmarried youth in Vientiane, Lao PDR: The role of parent-youth interactions and peer influence

Research indicates that adolescents in low-income countries have an early sexual debut and engage in risky sexual behaviours. Few studies in low-income countries however, have explored the factors that influence young people's sexual behaviours. This study examined individual, family and peer-level factors associated with premarital sexual behaviours in the Lao People's Democratic Republic (PDR). A cross-sectional survey was undertaken with unmarried youth aged 18 to 24 years (N = 1200) in Vientiane Capital City. Logistic regression models, controlling for confounding variables, were employed to test for the contribution of factors influencing premarital sexual activity. Most respondents held positive attitudes towards premarital sex, with males having more liberal attitudes than females (mean score of 2.68 vs. 2.32, p < 0.001). Prevalence of premarital sexual activity was higher among males than females (44.7% and 19.2%, respectively). Predictors of premarital sex for males were age, sexual attitudes, perceived parental expectations regarding sex, dating and peer influence. For females, predictors were father's level of education, parent-youth sexual communication, peer influence and liberal sexual attitudes. The results highlight the role of parent-youth interaction and peer influence. The results suggest the need for a range of strategies at the individual, peer and family level, as well as a gender-specific focus