Quality and utilisation of antenatal care services in Lao PDR

Background Antenatal care (ANC) plays an important role in reducing maternal mortality and morbidity by detecting early risk factors in order to have an effective intervention in time and by linking the pregnant women to a planned delivery with a skilled birth attendant. However, the utilisation of ANC services of pregnant women is problematic in many low-income countries, and in Laos only 39% used the services in 2005. Aims To assess the quality and utilisation of ANC services in rural areas of the Lao PDR (Lao People’s Democratic Republic), to explore the care providers' views on their antenatal services, to explore the women’s experiences of pregnancy complications and their opinions regarding ANC services, and to measure the impact of a communitybased intervention combined with strengthening of the ANC service. Methods The studies were conducted in rural areas of Laos between 2008 and 2011. We interviewed recently or currently pregnant women about factors related to their ANC utilisation, using structured interviews (n= 460, Study I). Fifty-nine ANC providerclient sessions were observed and semi-structured interviews were carried out with 26 health care providers (Study II). Eight focus group discussions were performed among women who had been or were pregnant (Study III). A low-cost ANC up-grading community-based intervention was assessed using structured interviews [n= 460 before (Study I) and n= 317 after the intervention (Study IV)]. Results About 50% of the women had had at least one ANC visit; 63% of them had three or more. The factors associated with ANC use were women whose husbands were salaried employees (OR 2.66, CI: 1.45–4.88); 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) (Study I). Women younger than 18 years old when having their first pregnancy were less likely to use the services (OR 0.56, CI: 0.28–0.97). Some participants considered ANC a curative rather than a preventive service, seeking care only for pregnancy complications. Sparse or non-utilisation of services was also due to limited access to health facilities, negative attitudes towards health care providers, sub-quality of the services and lack of information about ANC (Study III). Traditional beliefs influenced the behaviour of pregnant rural Lao women. The prohibition of particular food items and restriction of certain behaviours were related to a fear of obstructed labour. Some of the practices indicated a lack of modern medical knowledge about what causes pregnancy-related problems. Perceived problems were dealt with by using modern health care or traditional medicine or a combination of both, but many of the problems were neglected (Study III). Overall, the quality and performance of ANC services in rural health facilities were poor due to lack of routines, scarce or insufficient equipment and limited skills among providers. The average consultation time for each woman was five minutes. The health care providers expressed having little competence and motivation to work with ANC. Compared to district hospitals, health centres had less equipment and supplies, and their care providers had less ANC training and a heavier work load (Study II). After the intervention, overall ANC use increased from 49% to 78% for the women in the intervention arm and from 54% to 64% in the control arm, displaying a significant intervention effect of 19 percentage units. Similarly, there were positive intervention effects of 26 and 24 percentage units, respectively, for making the recommended number of ANC visits and for making the visits at health centres (Study IV). Conclusions Several factors related to ANC utilisation. Besides limited access to the services and lack of awareness among the women regarding ANC, sub-quality of the services also inhibited pregnant women from seeking care. The low-cost intervention proved to greatly increase the proportion of ANC utilisation in a short period of time. This type of intervention can be recommended for implementation at a larger scale with an assessment of the quality of services

From plant selection by elephants to human and veterinary pharmacopeia of mahouts in Laos

International audienceEthnopharmacological relevanceTo what extent has animal observation contributed to the development of human pharmacopeias? We approach this question here through the study of mahouts’ knowledge regarding the responses by elephants to their health problems, and the human medicinal uses of plants and the care of domestic animals that result from their observations.Materials and methods32 mahouts were interviewed in Thongmyxay district and 28 at the Elephant Conservation Center in the province of Xayabury. Interviews focused on the elephants’ diet, health problems, plant items they consume in particular physiological or pathological contexts and the treatments that mahouts provide them. For each plant mentioned, the part of the plant consumed and mode of preparation and administration if used by mahouts were recorded. Species samples were then collected and later identified by specialists.Results114 species were recorded as being consumed by elephants during interviews with mahouts and forest outings with them to collect samples. Twenty species were identified as used by elephants in particular pathological conditions or physiological states. According to interviewed mahouts, the consumption of certain plants improves the health of the elephant. We observed clear convergences between the observations interpreted by the mahouts as self-medication behaviour from elephants and their own medicinal practices (for human and veterinary purposes).ConclusionBeyond a mere reproduction of elephant self-medication behaviours observed, the human or veterinary medicinal cares derived from these observations are the result of complex arrangements integrating all available medicinal and conceptual resources into elaborate preparations.We recommend that mahouts' knowledge about traditional medicinal care given to elephants be further compiled, as it could have a beneficial impact on veterinary health care provided in elephant resorts and elephants’ well-being

A metabolomic approach to identify anti-hepatocarcinogenic compounds from plants used traditionally in the treatment of liver diseases

International audienceLiver cancer is a major health burden in Southeast Asia, and most patients turn towards the use of medicinal plants to alleviate their symptoms. The aim of this work was to apply to Southeast Asian plants traditionally used to treat liver disorders, a successive ranking strategy based on a comprehensive review of the literature and metabolomic data in order to relate ethnopharmacological relevance to chemical entities of interest. We analyzed 45 publications resulting in a list of 378 plant species, and our point system based on the frequency of citation in the literature allowed the selection of 10 top ranked species for further collection and extraction. Extracts of these plants were tested for their in vitro anti-proliferative activities on HepG2 cells. Ethanolic extracts of Andrographis paniculata, Oroxylum indicum, Orthosiphon aristatus and Willughbeia edulis showed the highest anti-proliferative effects (IC50 = 195.9, 64.1, 71.3 and 66.7 μg/ml, respectively). A metabolomic ranking model was performed to annotate compounds responsible for the anti-proliferative properties of A. paniculata (andrographolactone and dehydroandrographolide), O. indicum (baicalein, chrysin, oroxylin A and scutellarein), O. aristatus (5-desmethylsinensetin) and W. edulis (parabaroside C and procyanidin). Overall, our dereplicative approach combined with a bibliographic scoring system allowed us to rapidly decipher the molecular basis of traditionally used medicinal plants

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

International audienceObjectiveEpilepsy 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

Differences in knowledge about epilepsy and antiepileptic drugs among pharmacy-dispensing workers in Cambodia and in Lao PDR

International audienceEpilepsy is the most common neurological disorder encountered in primary care in Southeast Asia. People with epilepsy require long-term therapy management. Nonadherence to antiepileptic drugs (AEDs) has been identified as a major factor in suboptimal control of epilepsy. Pharmacies offer patients a first-line point of contact with the healthcare system. Many pharmacies operate with limited or nonqualified human resources that can lead to insufficient knowledge, inappropriate supply of medicines, and insufficient counseling.Objective: The aim of this study was to evaluate the qualification and knowledge concerning epilepsy and AEDs among pharmacy-dispensing workers who sell drugs to people with epilepsy.Method: A cross-sectional qualitative study was conducted in public and private pharmacies, in both urban and rural areas of Cambodia and Lao People's Democratic Republic (Lao PDR). The knowledge was collected through a questionnaire.Results: A total of 180 respondents from 123 outlets in the two countries were included in this study. A proportion of 40.8% (31) of respondents in Cambodia and 38.5% (40) in Lao PDR were pharmacists, followed by sellers who did not received any healthcare training with a proportion of 18.4% (14) in Cambodia compared to 20.2% (21) in Lao PDR. Head trauma was cited as the main cause of epilepsy by 72.4% (55) in Cambodia and 27.2% (28) in Lao PDR (p < 0.001). Epilepsy was considered as a contagious disease by 6.6% (5) of respondents in Cambodia compared to 18.4% (19) in Lao PDR (p = 0.03). Eighty-seven percent (66) of respondents in Cambodia knew at least one long-term AED versus 67.3% (70) in Lao PDR (p = 0.003). Phenobarbital was mentioned in more than 90.0% of cases in both countries. In overall, 15.4% (21) thought that if seizures are controlled for some months, people with epilepsy could stop taking their AEDs. Only one respondent from Lao PDR was aware of drug-drug interaction between AEDs and oral contraception.Conclusion: An educational intervention should be implemented to improve the knowledge of epilepsy and AEDs for pharmacy-dispensing workers. This could include advice for all pharmacy-dispensing workers in order to improve AED management and follow-up of therapeutic adherence