Aging, Diseases and Ecology in Community-Dwelling people living Songkohn District III~ IV

　ラオスにおける高齢者の糖尿病について、身体に刻まれた歴史と文化の側面から考察した。糖尿病に関する歴史、文化的背景（ラオス～サバナケット）として、7~10 世紀頃の中国南部より東南アジアへのタイ系民族の移動に始まり、ラオ民族のもち米の主食化がある。うるち米に比べて、高カロリー（1.4 倍）かつ高 Glycemic index　(2.0 倍) であるのが、うるち米の特徴である。魚の生食とタイ肝吸虫の慢性感染、妊婦の産後数ヶ月のタンパク摂取制限（タブー）、1974 年以降のJICA も絡んだサトウキビ畑の大規模開発による砂糖の市場への普及（モノ班、天理教資料より）、1978 年の大洪水による食糧難（特にラハナム）（過去に繰り返している可能性）、1997 年以降のラハナムの灌漑設備による2 期作による収量増加と余剰による換金化の可能性などの経済的な要因とライフスタイルの影響が糖尿病の増加に影響している可能性がある。この10 年間、サバナケット病院の糖尿病受診者が実際増加しているが、地域住民の高い有病率から考えるとまだかなり少ない。伝統的なライフスタイルのラハナムと、市場経済の浸透し始めているパキソンを比較すると、高齢者の糖尿病の頻度に差はないが、50 歳台の糖尿病やメタボリックシンドロームの頻度は、パキソンの方が高い。若年者のライフスタイルや栄養転換の市場経済による影響の変化が大きいことが考えられる。、同じ民族背景をもつが、経済的に発達しているタイのコンケンでは、糖尿病の頻度がはるかに多くなっていることから、ラオスにおける糖尿病の将来の増加が危惧される。糖尿病の予防に向けての、今後の対策が急務である。来年度は、ラオスの北部住民における生活習慣病を含めた健康状態を調査し、森林農業班との資源、土地利用との関連から分析するとともに、南部の住民との比較を行うことにより、老化と疾患に及ぼす生態史的アプローチを深めていこうと考えている

Soil-transmitted helminth infections and risk factors in preschool children in southern rural Lao People's Democratic Republic

The current widespread school-based control of soil-transmitted helminth (STH) infections is also advocated for preschool children. The objective of this study was to assess infection with STHs as well as their determinants in preschool children (<60 months) in southern rural Lao People's Democratic Republic (Lao PDR). A cluster survey was carried out from October to December 2006 in three districts of Savannakhet Province. The prevalence of Ascaris lumbricoides, hookworm and Trichuris trichiura was 27.4% (95% CI 27.0-27.6%), 10.9% (95% CI 10.7-11.0%) and 10.9% (95% CI 10.7-11.1%), respectively. Of the children studied, 28.4% had a monoparasitic infection and 9.3% had a polyparasitic infection. Older children had a higher risk for hookworm infection [odds ratio (OR) = 1.75, 95% CI 1.03-3.01; P = 0.041] and multiple infections (OR = 1.81, 95% CI 1.01-3.20; P = 0.044). Low socioeconomic status was associated with A. lumbricoides (OR = 0.61, 95% CI 0.38-0.98; P = 0.043) and monoparasitic infections (OR = 0.62, 95% CI 0.38-0.99; P = 0.049). In Lao PDR, deworming of preschool children is warranted. Preventive measures should address important risk factors. Health education regarding personal hygiene, appropriate water management and the construction and proper use of latrines are additional essential element

Present Conditions and Problems of School Health in Lao P.D.R : National School Health Policy: Establishment through Cooperating of Education and Health Sectors

It is emphasized that cooperation between the education and health sectors is very important to improve child health conditions through the advancement of school health in many developing countries. At the same time, improving children's health is very important for achievement of “Education For All" (EFA). Actually, this cooperation is very difficult to realize in many nations. However, in Lao P.D.R, establishment and implementation of a school health policy is by the cooperation of education and health sectors at a national level. This report aims to examine the reasons “Why it is going successfully?" hand, to give some information about how to develop international school health activities.Four points were examined as to reasons why this success was possible: 1) Lao P.D.R had much experience and knowledge about helminth-parasite control at schools. 2) From an early stage, both sectors cooperated, and the system was supported by international organizations, JICA, etc. 3) A new task force for school health was formed, because they did not have a position at both ministries. As well, it had a clear purpose of “establishment of school health". 4) When new task force became plan, school health was clearly located at the national level for the achievement of EFA and Millennium Development Goals (MDGs).Now, school health of Laos is still just beginning. The execution stage of the school health policy was thought to be important. For example, integration of the knowledge and experiences of each organization, strengthening the initiative of the Laos nation about school health, function of the ministry of education for school health, correspondence regarding geographical inequities, and race differences are considered to be important factors

Anemia and Related Factors in Preschool Children in the Southern Rural Lao People’s Democratic Republic

Anemia is a severe public health problem in the Lao People’s Democratic Republic (PDR). Consequently, a new control strategy to reduce the burden of anemia has been introduced for preschool children (aged 6–52 months). The objective of this study was to assess the current prevalence of anemia and related factors in preschool children in southern rural Lao PDR. A population-based cross-sectional study was carried out in six communities in Songkhone district, Savannakheth province, in February 2009. As a result, the prevalence of anemia was found to be 48.9% (95% confidence interval (CI), 43.5–54.3), although most cases were mild. A multiple logistic regression analysis indicated that there was no protective effect of breastfeeding against anemia. The anemia prevalence was higher in 1) children aged 6–23 months (Odds Ratio (OR) = 1.73, 95% CI, 1.02–2.90) than in older children, 2) children in large families (6 or more members) (OR = 1.96, 95% CI, 1.17–3.29), and 3) children in three remote villages with relatively difficult access to markets (OR = 3.01, 95% CI, 1.25–7.47)

Effect of daily versus weekly home fortification with multiple micronutrient powder on haemoglobin concentration of young children in a rural area, Lao People's Democratic Republic: a randomised trial

RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are.Abstract Background Multiple micronutrient deficiencies, in particular iron deficiency anaemia (IDA) is a severe public health problem in Lao People's Democratic Republic (Lao PDR). Because of the practical difficulties encountered in improving the nutritional adequacy of traditional complementary foods and the limitations associated with the use of liquid iron supplementation for the treatment and prevention of IDA in infants and young children, recently, home-fortification with multivitamins and minerals sprinkles was recommended. This study aims to compare the effect of twice weekly versus daily supplementation with multivitamins and minerals powder (MMP) on anaemia prevalence, haemoglobin concentration, and growth in infants and young children in a rural community in Lao PDR. Methods A randomized trial was conducted in six rural communities. Children aged 6 to 52 months (n = 336) were randomly assigned to a control group (n = 110) or to one of two intervention groups receiving either two sachets per week (n = 115) or a daily sachet (n = 111) of MMP for 24 weeks; 331 children completed the study. A finger prick of blood was taken at baseline, at week 12, and again at week 24 to determine haemoglobin concentration. Anthropometric measurements were taken every 4 weeks. The McNemar test was used to assess within group differences at three time points in the study subjects with anaemia and one-way ANOVA was used to assess changes in mean haemoglobin concentration in the treatment groups. Results MMP supplementation resulted in significant improvements in haemoglobin concentration and in the reduction of anaemia prevalence in the two treatment groups compared with the control group (p <0.001). The severely to moderately anaemic children (Hb <100 g/L) on daily supplementation recovered faster than those on twice weekly supplementation. MMP was well accepted and compliance was high in both treatment groups. Overall, the improvement in the weight for age Z-score was very small and not statistically significant across the three study groups. Conclusions MMP supplementation had positive effects in reduction of anaemia prevalence and in improving haemoglobin concentration. For severely to moderately anaemic children, daily MMP supplementation was more effective in improving haemoglobin concentration and reducing anaemia prevalence. A longer intervention period is probably needed to have a positive effect on growth.Peer Reviewe

Bridging the gaps among research, policy and practice in ten low- and middle-income countries: Development and testing of a questionnaire for researchers

<p>Abstract</p> <p>Background</p> <p>A questionnaire could assist researchers, policymakers, and healthcare providers to describe and monitor changes in efforts to bridge the gaps among research, policy and practice. No questionnaire focused on researchers' engagement in bridging activities related to high-priority topics (or the potential correlates of their engagement) has been developed and tested in a range of low- and middle-income countries (LMICs).</p> <p>Methods</p> <p>Country teams from ten LMICs (China, Ghana, India, Iran, Kazakhstan, Laos, Mexico, Pakistan, Senegal, and Tanzania) participated in the development and testing of a questionnaire. To assess reliability we calculated the internal consistency of items within each of the ten conceptual domains related to bridging activities (specifically Cronbach's alpha). To assess face and content validity we convened several teleconferences and a workshop. To assess construct validity we calculated the correlation between scales and counts (i.e., criterion measures) for the three countries that employed both and we calculated the correlation between different but theoretically related (i.e., convergent) measures for all countries.</p> <p>Results</p> <p>Internal consistency (Cronbach's alpha) for sets of related items was very high, ranging from 0.89 (0.86-0.91) to 0.96 (0.95-0.97), suggesting some item redundancy. Both face and content validity were determined to be high. Assessments of construct validity using criterion-related measures showed statistically significant associations for related measures (with gammas ranging from 0.36 to 0.73). Assessments using convergent measures also showed significant associations (with gammas ranging from 0.30 to 0.50).</p> <p>Conclusions</p> <p>While no direct comparison can be made to a comparable questionnaire, our findings do suggest a number of strengths of the questionnaire but also the need to reduce item redundancy and to test its capacity to monitor changes over time.</p

Assessing healthcare providers' knowledge and practices relating to insecticide-treated nets and the prevention of malaria in Ghana, Laos, Senegal and Tanzania

Abstract Background Research evidence is not always being disseminated to healthcare providers who need it to inform their clinical practice. This can result in the provision of ineffective services and an inefficient use of resources, the implications of which might be felt particularly acutely in low- and middle-income countries. Malaria prevention is a particularly compelling domain to study evidence/practice gaps given the proven efficacy, cost-effectiveness and disappointing utilization of insecticide-treated nets (ITNs). Methods This study compares what is known about ITNs to the related knowledge and practices of healthcare providers in four low- and middle-income countries. A new questionnaire was developed, pilot tested, translated and administered to 497 healthcare providers in Ghana (140), Laos (136), Senegal (100) and Tanzania (121). Ten questions tested participants' knowledge and clinical practice related to malaria prevention. Additional questions addressed their individual characteristics, working context and research-related activities. Ordinal logistic regressions with knowledge and practices as the dependent variable were conducted in addition to descriptive statistics. Results The survey achieved a 75% response rate (372/497) across Ghana (107/140), Laos (136/136), Senegal (51/100) and Tanzania (78/121). Few participating healthcare providers correctly answered all five knowledge questions about ITNs (13%) or self-reported performing all five clinical practices according to established evidence (2%). Statistically significant factors associated with higher knowledge within each country included: 1) training in acquiring systematic reviews through the Cochrane Library (OR 2.48, 95% CI 1.30-4.73); and 2) ability to read and write English well or very well (OR 1.69, 95% CI 1.05-2.70). Statistically significant factors associated with better clinical practices within each country include: 1) reading scientific journals from their own country (OR 1.67, 95% CI 1.10-2.54); 2) working with researchers to improve their clinical practice or quality of working life (OR 1.44, 95% CI 1.04-1.98); 3) training on malaria prevention since their last degree (OR 1.68, 95% CI 1.17-2.39); and 4) easy access to the internet (OR 1.52, 95% CI 1.08-2.14). Conclusions Improving healthcare providers' knowledge and practices is an untapped opportunity for expanding ITN utilization and preventing malaria. This study points to several strategies that may help bridge the gap between what is known from research evidence and the knowledge and practices of healthcare providers. Training on acquiring systematic reviews and facilitating internet access may be particularly helpful

Health and nutritional ecology of rural adults in SVK

2005 年9 月にラオス・サバナケット県ソンコーン郡ラハナム地区（６村落）のうちベンカムライ村を除く５村落の成人（１５歳～５９歳）を対象として、身体計測（身長・体重・上腕囲・皮脂厚）・最大／最小血圧・空腹時血糖・試験紙を用いた半定量的尿試験、を行った。ランダムサンプリングを目指したが、実際には３０代・４０代のしかも男性より女性の参加が多く（男２２２人、女４５０人、合計６７２人）、参加率は男性対象者の約２０％、女性対象者の約３０％であった。その結果、１）身体計測値に年代間差が見られ、近年の栄養状態の改善が示唆された。２）過体重と肥満者割合は男性より女性で高く、加齢と共に上昇していた。３）高血圧者割合は男女とも年齢と共に高くなり、身体計測値を独立変数とした重回帰式では最大／最小血圧とも２５％説明でき、体重やBMI・年齢・脈拍は正に、上腕囲は負に寄与していた。４）空腹時血糖値から判断した糖尿病者割合は男性より女性で高い傾向にあり、５０歳代では２０％に達していた。５）尿検査からは潜在的な腎機能障害（腎臓結石）や感染症の高さが伺えた。以上の全ての検査項目を独立変数とし、糖尿病のレベルを従属変数として累積ロジスティック回帰分析を行ったが、糖尿病者が少なかったためもあり糖尿病のレベルを判別できる回帰式は得られなかった。以上のことから、ラハナム地域の成人男女に慢性病と感染症が共に存在することが示唆されたが、これらの成因を明らかにするには本報告で扱わなかった食生活や活動、環境条件や薬物使用などの重要な要因を検討する必要がある。Health examination including anthropometry, blood pressure, blood glucose, and urinary dipstick test, was conducted in September 2005, subjecting adult (between 15 and 59 years old) people in 5 of 6 villages in Lahanam, Songkhon district, Savannaket province, Laos. Two hundred twenty two males and four hundred fifty females (six hundred seventy two in total), largely in their 30s and 40s, participated in the study (participation rate of males and females was about 20 and 30 % , respectively). The results are as follows. 1) Anthropometry showed inter-generation difference, which may indicate recent nutritional improvement. 2) Proportion of overweight (BMI>25) and obesity (BMI>30) was higher in females, with generation difference in BMI in both sexes. 3) Proportion of normotension/hypertension increased with ageing in both males and females. About25% of either systolic or diastolic blood pressure was explained by the multiple regressions with anthropometry as independent variable (body weight, BMI, pulse and age contributed positively and upper arm circumference negatively). 4) Proportion of diabetes mellitus judged by fasting blood glucose was higher in females than in males, and the former reached about 20% in their 50s. 5) Results from urinary dipstick test indicated potentially high prevalence of infections and functional disorder in kidney, kidney stone, in particular. Accumulate logistic regression analysis was conducted to discriminate DM type (dependent variable) with all the measurements (including results of urinary dipstick test) as independent variables, however, significant regression was not obtained partly because few (26) DM cases for 672 subjects. It was concluded that both infectious and chronic diseases exist in adult people in Lahanam　area. In order to disclose their attributes, it is needed to examine more critical factors such as food habits, activities, environmental conditions and drug use, which were not treated in this paper

Water utilization situations at two suburban areas in Lao P.D,R. - The cases of Lahanam district, Savannakhet and its changing pattern in Xaithani district in Vienntiane Capital -

Utilization and availability of water source is a serious health problem in developing countries. To analyze local condition of water utilization patterns in Lao PDR, a comparative study on water utility and sanitation condition along the local context was conducted at 2 villages in Savannakhet province and a village in Vientiane Capital in 2005. There was no city water supply in the two areas. Water utilization and the sanitation data of the Capital village in 2000 were also employed to compare change of the situation for 6 years at the place. In Savannakhet, main water sources were dug well, river, purchase-bottle water, and rainwater storage. Rainwater was common drinking source, and a half of them drink before boiling. In the capital area, main water sources were well (borehole and dug wells), purchase-bottle water both in 2000 and in 2005. Utilization of drinking water, well water was chosen firstly and the water boiling practice rates were not so different in both areas. The consumption of purchase water was higher in Vientiane than in Savannakhet. Also, it was demonstrated that the rate of purchase water increased much at the capital in these six years