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

Health Status of Reproductive -age Females in Rural Laos from the Perspective of Anthropometry and Hemoglobin Level.

　The objectives of this study are to elucidate 1) the health status and its’ seasonal variation of reproductive age female villagers in Lahanam zone, Sonkhon district, Savannakhet province of Lao PDR, and 2) the relevant factors in relation to socioeconomic characteristics of their households. Data of the present study were collected in rainy season between 7th and 25th August 2005, and in dry season between 6th and 13th February 2006, based on the authors’ field research in five villages. Randomly selected 113 females, 20 to 40 years old, were studied in 2005; rainy season. Within 113 subjects of rainy season survey, 29 subjects were excluded; the person who were pregnant and breast feeding, moved to other place, thus 84 females were studied in 2006; dry season. Measurements were done for anthropometric variables, hemoglobin level, blood pressure, resting metabolic rate (RMR), and difference between two seasons were calculated. Socioeconomic characteristics of the subjects were obtained by village health volunteers, using structured interviews.　From the results of the anthropometric measurements and hemoglobin level, it can be said that the nutritional statuses of the five villagers were better than that of females in the national survey. Furthermore, the percentages of the overweight (BMI over 25) of the present study (16.8% in rainy season and 22.6% in dry season) were higher than the result of adult females in national survey (10.8 % ). It should be noted that the problems of undernutrition and overnutrition occur in the same village at same time, similarly to a modernizing populations in other developing countries. Among socioeconomic characteristics, the environmental factors such as area of irrigated rice field, and the main sources of the foods played important roles for the health status of the subjects in rural village in the Sonkhon district

Development and validation of food frequency questionnaire for estimating food and nutrient intakes of people in rural Laos

　Food frequency questionnaire (FFQ) has been developed for estimating food and nutrient intakes at both individual and group levels. The foods listed for FFQ have been chosen based on the data of semi-weighed dietary record (DR) collected in autumn, 2004 from children in Lahanam area, and other qualitative information on the dietary habits of Lao population. The validation study with FFQ and 3-day DR was performed using 113 adult women in Lahanam in summer, 2005. Mean intakes of some food groups were severely overreported in FFQ than in DR although the food list of FFQ almost covered major foods necessary for the assessment of the target population. In order to minimize over/underreporting tendency by food group, the portion sizes in the calculation algorism of FFQ were corrected using the over/underreport ratios of food groups. After this correction, nutrient intakes estimated from FFQ were compared with those assessed with DR at individual and village levels. Mean nutrient intakes of the whole population estimated from FFQ were close to those assessed with DR. However, the correlation coefficients of nutrient intakes between the two methods were null or low (r ranged from -0.14 [ % energy of fat] to 0.21 [niacin]). In contrast, the correlation analysis showed a reasonable reproducibility between the two FFQs assessed one-month apart (r ranged from 0.07 [retinol] to 0.60 [carbohydrate]). Further consideration with careful checking of the collected data may be necessary to develop a reliable and usable FFQ for people in rural Laos

Dietary intake and the indicators of dietary change for females of reproductive age

　The objectives of this study are to understand amount of food consumption and nutrients intake, and changing dietary pattern for females of reproductive age in Lowland of Laos, Lahanam zone in Sonkhon district, Savannakhet province. We randomly selected 113 women aged 19-40 years in 5 villages. The period of the data collection is August to September, 2005. One subjects was visited for 3 days with 4 days interval. The mean of 3 days dietary records was used as the person’s dietary data. The subjects living in Kokphok, where is in most traditional environment and lifestyle, consumed more cereals, other vegetables, mushrooms and sea/river weed than subjects living in other villages in average. The intake levels of fat 13g/day, calcium 406mg/day, iron 13mg/day, and retinal 320mg/day were very low compare with RDA of Thailand and WHO/FAO. The energy density values of protein, fat, carbohydrate in the subjects’ diet, were 13% , 7% , 80% . Fat intake level in energy density (% ) was related sugars, fat & oils, meats, eggs positively, but cereals and other vegetables negatively. It related skinfold thickness positively. High economic status, such as owner of TV/Video, relate fat intake both in crude value and energy density value. These results suggest penetrate of cash economy change dietary pattern, and induce high fat intake and physical fatness

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)

Susceptibility to vaccine-preventable diseases in four districts of Xaysomboun Province, Lao people’s Democratic Republic

Xaysomboun province has some of the lowest health indicators in Lao People’s Democratic Republic (PDR). This cross-sectional study aimed to determine the vaccination, susceptibility and exposure status of the population to hepatitis B virus (HBV), measles, rubella, and tetanus. Participants aged 5 years and older were randomly selected from four districts. From each enrolled participant, demographic data and 5 mL of blood sample were taken. HBV surface antigen (HBsAg) and antibodies against HBV, measles, rubella, and tetanus were detected by ELISA. A total of 363 participants (age 5 to 80 years) were included. HBV exposure, as determined by anti-HBV core (anti-HBc) antibodies, was 56.2% overall, and was significantly higher among those aged ≥21 years (78.1%). HBsAg was detected in 9.4% overall and increased to 20% in ages 31–40 years. Only 13.8% of participants had serology indicative of vaccination (anti-HBs positive, anti-HBc negative). Seroprotection against measles was 74.6% overall but only 41.7% in children aged 5–10 years. Anti-rubella IgG was 94.2% overall and high in all age groups. Tetanus seroprevalence was only 47.4% overall but significantly higher in females aged 31–40 (75.6%). We suggest strengthening of routine and booster HBV, measles, and tetanus vaccine coverage in Xaysomboun province

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

Effects of Daily Zinc, Daily Multiple Micronutrient Powder, or Therapeutic Zinc Supplementation for Diarrhea Prevention on Physical Growth, Anemia, and Micronutrient Status in Rural Laotian Children: A Randomized Controlled Trial.

ObjectivesTo evaluate the optimal zinc supplementation strategy for improving growth and hematologic and micronutrient status in young Laotian children.Study designIn total, 3407 children aged 6-23 months were randomized to receive either daily preventive zinc tablets (7 mg/d), high-zinc, low-iron micronutrient powder (10 mg/d zinc, 6 mg/d iron, and 13 other micronutrients), therapeutic zinc supplementation for diarrhea (20 mg/d for 10 days per episode), or daily placebo powder; all were followed for ~9 months. Anthropometry, hemoglobin, zinc, and iron status were assessed at baseline and endline. Analyses were by intention-to-treat, using linear and modified Poisson regression.ResultsAt baseline, mean (±SD) age was 14.2 ± 5.1 months and stunting and anemia prevalence were 37.9% and 55.6%, respectively. At endline, zinc deficiency in the preventive zinc (50.7%) and micronutrient powder (59.1%) groups were significantly lower than in the therapeutic zinc (79.2%) and control groups (78.6%; P &lt; .001), with no impact on stunting (37.1%-41.3% across the groups, P = .37). The micronutrient powder reduced iron deficiency by 44%-55% compared with other groups (P &lt; .001), with no overall impact on anemia (P = .14). Micronutrient powder tended to reduce anemia by 11%-16% among children who were anemic at baseline (P = .06).ConclusionsDespite improving zinc status, preventive zinc and micronutrient powder had no impact on growth. The micronutrient powder improved iron status and tended to reduce anemia among the subset of previously anemic children.Trial registrationClinicalTrials.govNCT02428647

Prospects for the development of community-based care in remote rural areas: a stakeholder analysis in Laos

Background Community-based health programmes have been a cornerstone of primary care in Laos for decades. The study presented here aimed to document prospects for the development of current programmes, considering perceptions about health and health care priorities in the communities, implementation challenges, the policy landscape and opportunities associated with the availability of new technologies. Methods The research design primarily involved qualitative in-depth interviews with stakeholders (n = 35) responsible for the planning, management, or implementation of community-based care in Laos at different levels of the health system. These included health managers at central departments or institutes of the Ministry of Health, provincial health departments, district health offices, heads of health centres, village health volunteers, community representatives, and international stakeholders. Results There was consensus that service delivery is still a challenge in many areas, due to geographic inaccessibility of health facilities, communication barriers, health-seeking behaviour, trust, and gender discrimination, particularly among ethnic minorities. In these settings, community health workers have the potential to extend the reach of the formal health system, acting as cultural brokers across sectors of society, ethnicities, and worldviews. To maximise impact, planners need to carefully consider the implementation model, financing arrangements, health system integration, and changing health priorities in the communities. Conclusions This study examined challenges to, and opportunities for, the expansion and health system integration of community-based care in Laos. Further development and horizontal integration of community-based care remains a complex financing and governance challenge, although the renewed emphasis on primary care and the ongoing process of decentralisation provide a favourable policy environment in the country to sustain and potentially expand existing programmes