Seroepidemiology of Foot and Mouth Disease using passive surveillance techniques in selected provinces of Lao PDR.

Foot and Mouth Disease (FMD) is a high-impact, contagious transboundary animal disease that is endemic in Southeast Asia. Abattoir samples were routinely collected in six selected provinces between March and December 2019. A total of 1280 samples of abattoir animals were tested for FMD Non-Structural Protein (NSP) antibodies to indicate natural infections. Overall, 22.8% were seropositive for FMD NSP antibodies while seroprevalence of cattle (n = 469), buffalo (n = 214), and pigs (n = 597) were 44.6%, 35.0%, and 1.3%, respectively. The highest seroprevalence destination province was Xiengkhouang (35.3% of 272 samples), followed by Savannakhet (27.0% of 244 samples). Risk factors for evidence of natural infection identified by a multivariate logistic regression model included age groups (p-value = 0.02) and origin provinces (p-value = 2.8 × 10-5) of the animals. There were significant differences of FMD NSP seroprevalence between age groups and origin provinces of the animals. The odds ratio of a seropositive result in the less than 1 year old group was 2.5 (95% CI; 1.4, 4.4) when compared to the 3-4 years old group, while the odds ratios for animals that originated from Khammouane and Xiengkhouang provinces were 4.5 (95% CI; 1.1, 18.7) and 2.4 (95% CI; 1.4, 4.1), respectively, when compared to Champasak province. Serotype-specific antibody ELISA for 44 NSP antibody-positive samples revealed evidence of FMD serotypes O and A virus circulation in some provinces. Despite the passive abattoir survey providing useful information on FMD virus previous exposure and geographic locations of the animals, timely information on FMD virus circulation and distribution is also crucial to an effective control program. Alternative approaches to increase the cost-effectiveness of the surveillance network are also discussed.

Risk factors of foot and mouth disease in an endemic area on low vaccination rate in Xayaboury province of Lao People's Democratic Republic (Lao PDR).

In Xayaboury province, located in the northern region of Lao PDR, the foot and mouth disease (FMD) vaccination campaign just began in 2009. Up until now, a small number of farms have been vaccinated. When FMD outbreaks occur, it is interesting to determine the risk factors of FMD, especially in the area where vaccination rates are low. The questionnaire survey, using a case-control design at the household level, was carried out. From 59 villages with a total number of 434 households, 181 households who experienced FMD were assigned as case households, 146 households without FMD occurrence inside the outbreak villages as inside control households, and 107 households without FMD occurrence outside the outbreak villages as outside control households. Household owners were interviewed. The logistic regression model was used to identify the relationship between FMD occurrence (dependent variable) and the collected data (independent variables), including the social status of livestock owners, FMD prevention strategies, and farm locations. A non-parametric test was performed to determine the association of FMD and network parameters of animal movements among villages. In general, results show that a limited number of holders did vaccinate animals before the outbreaks (13.8-17.8%). The results indicated that livestock owners who had known information about FMD before the outbreaks had been less severely affected by the FMD outbreak than the owners who had not known information about FMD (P < 0.01, OR 0.16, 95% CI 0.09-0.29). Before the outbreaks, higher FMD risk was observed in owners who sold the livestock through animal traders (P < 0.01, OR 4.76, 95% CI 1.68-13.50). Spatial data show that households in the community closer to the main roads had higher FMD risk (P < 0.01, OR 4.76, 95% CI 1.68-13.50). In addition, the network parameters including in-degree, out-degree, and betweenness indicated that the villages with high movements of livestock were at high risk of FMD (P < 0.05). The present study emphasized the importance of the government units to distribute the information about FMD to all livestock farmers in Xayaboury. Disease awareness and prevention strategy should be prioritized in areas close to high density communities and in the trading of livestock.

'Fit for school' - a school-based water, sanitation and hygiene programme to improve child health: Results from a longitudinal study in Cambodia, Indonesia and Lao PDR.

BACKGROUND: The Fit for School (FIT) programme integrates school health and Water, Sanitation and Hygiene interventions, which are implemented by the Ministries of Education in four Southeast Asian countries. This paper describes the findings of a Health Outcome Study, which aimed to assess the two-year effect of the FIT programme on the parasitological, weight, and oral health status of children attending schools implementing the programme in Cambodia, Indonesia and Lao PDR. METHODS: The study was a non-randomized clustered controlled trial with a follow-up period of two years. The intervention group consisted of children attending public elementary schools implementing the FIT programme, including daily group handwashing with soap and toothbrushing with fluoride toothpaste, biannual school-based deworming; as well as construction of group handwashing facilities. Control schools implemented the regular government health education curriculum and biannual deworming. Per school, a random selection of six to seven-year-old grade-one students was drawn. Data on parasitological infections, anthropometric measurements, dental caries, odontogenic infections and sociodemographic characteristics were collected at baseline and at follow-up (24 months later). Data were analysed using the χ2-test, Mann Whitney U-test and multilevel logistic and linear regression. RESULTS: A total of 1847 children (mean age = 6.7 years, range 6.0-8.0 years) participated in the baseline survey. Of these, 1499 children were available for follow-up examination - 478, 486 and 535 children in Cambodia, Indonesia and Lao PDR, respectively. In all three countries, children in intervention schools had a lower increment in the number of decayed, missing and filled permanent teeth between baseline and follow-up, in comparison to children in controls schools. The preventive fraction was 24% at average. The prevalence of soil-transmitted helminth infection (which was unexpectedly low at baseline), the prevalence of thinness and the prevalence of odontogenic infections did not significantly differ between baseline and follow-up, nor between intervention and control schools. CONCLUSIONS: The study found that the FIT programme significantly contributed to the prevention of dental caries in children. This study describes the challenges, learnings and, moreover, the importance of conducting real-life implementation research to evaluate health programmes to transform school settings into healthy learning environments for children. The study is retrospectively registered with the German Clinical Trials Register, University of Freiburg (Trial registration number: DRKS00004485, date of registration: 26th of February, 2013).

Promoting transboundary animal disease risk management via a multiple health and husbandry intervention strategies in upland Lao PDR.

Surveys of smallholder farmer knowledge, attitude, practice (KAP) and income were conducted in 2011 and 2012 in five northern provinces of Lao People's Democratic Republic (Lao PDR; n = 200 farmers). Participating villages were classified as either from a livelihood development project (LV; n = 80 farmers) or a livestock research project that contained both 'high-intervention' (HI; n = 60 farmers) or 'low-intervention' (LI; n = 60 farmers) villages. Farmer training plus a suite of health and productivity interventions were implemented in HI sites; only vaccination was implemented in LI sites, whilst various interventions and limited vaccination were introduced to LV sites. Farmer interviews were conducted with survey questions on socioeconomic variables and KAP of large ruminant health and disease risk management, enabling determination of quantitative and dichotomous qualitative traits and comparison of results from HI, LI and LV villages. The average farmer income from sales of large ruminants in HI was USD 621, in LI was USD 547 and in LV was USD 225 (p < 0.001). The predicted mean of total knowledge scores (/42) in the 2012 survey in HI was 28, in LI was 22 and in LV was 17 (p < 0.001). We conclude that improved KAP of large ruminant health and production can be achieved by intensive training, although with some farmers yet to apply their knowledge on husbandry and biosecurity practices, continued learning support and closed linkage of research and development projects to improve extension capacity is recommended. This multiple participatory approach promoting biosecurity in addition to vaccination may provide a more sustainable pathway for the advancement of Lao PDR on the Progressive Control Pathway for foot and mouth disease control.

Livestock movement patterns in the main livestock production provinces of Lao PDR.

Foot-and-mouth disease (FMD) is a highly infectious transboundary disease that is endemic and affects the livelihood of smallholder farmers in Lao People's Democratic Republic (PDR). Knowledge about livestock movement patterns is important for preventing the spread of FMD between villages. This study describes the livestock movement patterns in Champasak, Savannakhet and Xiangkhouang provinces of Lao PDR. Face-to-face interviews were conducted with randomly selected villagers (n = 195) and traders (n = 169) in 115 villages between February and March 2019. Livestock owners commonly purchased (mainly breeding) animals from other smallholders (81%) and sold (mainly slaughter) animals to traders (76%) or other smallholders (16%), typically within the same district and province. The median inter-village trade distance was 20-30 km, with an average frequency of 4 trades per village per month. Traders purchased animals from smallholders (71%) and middlemen (25%) located within their district. It was common for many traders (74%) to retain animals at their property before selling, typically a median of 4 beef cattle per trader. Local trades within the district were far more common (72%) than distant trades. The movements of grazing/fattening large ruminants between villages were reported in 30% of the villages in all three provinces and occurred mostly within the same district or province in short distance (6 km). Social Network Analysis has identified animal movement hubs in the three provinces which could be targeted for FMD control and surveillance. Movements of animals for further use (fattening/ reproduction), long-distance movements and frequent local movements described in this area have important implications for FMD circulation. The findings from the study will inform FMD spread simulation models for Lao PDR. The knowledge gained from these data will also help the Lao PDR authorities understand the patterns of animal movements associated with disease spread.

Changes in farmer animal health and biosecurity knowledge, attitudes and practices: Insights from Cambodia and Laos.

Livestock agriculture in Cambodia and Laos is severely affected by endemic and exotic transboundary animal diseases, impacting household livelihoods and food and nutritional security. Collaborative animal health and biosecurity projects were conducted in each country between 2015 and 2019 aimed at increasing smallholder livestock production through mainly knowledge-based interventions in large ruminant disease prevention, nutrition, reproduction and marketing access. This study's objectives were to identify baseline animal health and biosecurity knowledge, attitudes and practices (KAP) of farmers, and temporal changes in key attitudes and practices associated with improved knowledge. Data for each country were analysed separately, and a formal between-country comparison was avoided due to major implementation and management differences. Binomial logistic regression without random terms compared the overall knowledge scores between 2015 and 2018 in each country, and binomial logistic regression with random terms was used to investigate possible associations between animal health and biosecurity knowledge scores and attitudes and practices. In Cambodia, the average animal health and biosecurity knowledge score increased from 4.8 (±2.2)/17 in 2015 to 13.0 (±2.8)/17 in 2018 (p < .0001). In Laos, the average scores improved from 7.2 (±2.5)/12 in 2015 to 7.9 (±2.9)/12 in 2018 (p = .0003). Clinical signs of foot-and-mouth disease were accurately reported by 100% of Cambodian and 88% of Lao project farmers, and overall, attitudes and practices improved in both countries over the study period. The belief that vaccination can improve livestock value was associated with increasing knowledge in both countries (Cambodia: OR 1.45, 95% CI 1.24-1.68, p < .0001; Laos: OR 1.43, 95% CI 1.16-1.75, p = .0006) as was the use of the services of village para-veterinarians if they had better training (Cambodia: OR 1.76, 95% CI 1.20-2.58, p = .004; Laos: OR 2.02, 95% CI 1.19-3.41, p = .009). However, the source of livestock information (District veterinary officials) was the only practice associated with knowledge in both Cambodia and Laos. The influence of resource scarcity on farmer decision making and knowledge measures was considered of particular relevance to the findings.

Foot-and-mouth disease seroprevalence and reporting behaviours in nine northern provinces in Lao PDR: The current situation and challenges for control.

Foot-and-mouth disease (FMD), caused by the FMD virus (FMDV), is one of the most important of global livestock diseases, impacting even-toed ungulates and distributed mostly in less developed countries that are home to 75% of the human population. A progressive control pathway for FMD (PCP-FMD) was developed to assist countries to better manage FMD risks and progress towards control and eradication. This requires evidence of current FMD seroprevalence to enable the informed risk assessment and the disease control planning required to progress along the initial stages of the PCP-FMD. Despite Laos being an active member of the South East Asia and China FMD campaign, these data have been challenging to obtain. To address this gap, a cross-sectional seroprevalence study in nine northern Lao provinces was conducted in early 2019. The study sampled 602 large ruminants and 19 goats from 30 villages. Overall, the large ruminant seroprevalence was 43.7% (95% CI 39.7-47.8), and 90% of sampled villages had at least one seropositive animal. Large ruminants suspected of having had clinical FMD in their lifetime were found to have an increased risk of being seropositive (odds ratio 1.96, 95% CI 1.06-3.65, p = .03). An examination of current reporting behaviours of farmers, village veterinary workers and district and provincial officials found that individuals were using their discretion as to whether disease events required reporting along the chain of command. This, plus the lack of a computerized reporting system, contributed to a loss of historical data, potentially compromising progression on the PCP-FMD. Laos requires ongoing support from donor agencies to improve the current animal disease surveillance system and implement effective FMD control strategies that can enable progress on the PCP-FMD.

Impact of risk-based partial vaccination on clinical incidence and seroprevalence of foot and mouth disease in Lao PDR.

Foot and mouth disease (FMD) is endemic in the Lao People's Democratic Republic (PDR) and it causes economic loss to smallholder husbandry systems. An intervention programme based on a risk-based partial vaccination strategy was implemented in three provinces of Lao PDR (Champasak, Savannakhet and Xiangkhouang) to immunise domestic cattle and buffalo during 2016-2020. Two cross-sectional surveys were conducted in 2016/17 and 2020 to evaluate the impact of the vaccination programme on the prevalence of FMD virus exposure and clinical incidence of the disease. A total of 212 villages were visited during the two surveys, collecting 1609 household-level questionnaire results and 5931 blood samples of domestic cattle and buffalo. Blood samples were tested for the presence of antibodies to the non-structural proteins of FMD virus, and seroprevalence of 42.5 and 47.5% in 2016/17 and 2020, respectively were found. Multivariable regression analysis indicated that the efficacy of the FMD vaccination programme for reducing FMD virus circulation varied by province. In general, the incidence of clinical FMD increased toward the end of the 5-year intervention period, coinciding with a reduction of vaccine coverage in the last 2 years of the period. The findings suggest that the risk-based vaccination strategy achieved a marginally protective effect against the circulation of FMD virus with the possible limiting factors being operational constraints of public veterinary services, lack of farmers' compliance and unsustainable funding. We conclude that consistent resource availability and higher vaccination coverage is required to successfully control FMD with a risk-based vaccination strategy in Lao PDR.

Socioeconomic impacts of clinical foot-and-mouth disease and a risk-based partial vaccination campaign for smallholders in Lao People's Democratic Republic.

Foot-and-mouth disease (FMD) is endemic in Lao People's Democratic Republic (PDR). A risk-based partial vaccination campaign was implemented in Champasak, Savannakhet and Xiengkhouang Provinces in Lao PDR in 2016-2020, which had limited effects on reducing the circulation of FMD virus. The objectives of this study were to measure the socioeconomic effects of (i) a clinical FMD occurrence and (ii) the vaccination campaign on livestock production performance of smallholders in Lao PDR in 2016-2020. Two questionnaire surveys were conducted at the beginning (2016) and the end (2020) of the campaign, involving 1609 smallholders in 160 villages comparing areas with and without FMD control. Mixed-effect multivariable regression models were fitted to measure the association between livestock production parameters at the household level (rates of birth, sale, purchase, and death, sale price, costs, gross gains and net gains) and (i) a clinical FMD occurrence and (ii) the vaccination campaign, while adjusting for village, herd size, province, vaccination status and FMD knowledge. We found no significant difference in annual household-level costs, gains and net gains by due absence of FMD. However, smallholders with FMD had a 52% higher cattle death rate, a 43% lower goat sale rate and a 78% lower pig sale price than those without FMD. Smallholders with FMD also had a lower purchase rate of livestock (cattle -15% and pigs -93%) compared with those without FMD. There was a general improvement in livestock production in target villages over the 5 years of the vaccination campaign, whereas there was an overall decline in non-target villages, resulting in USD 218 higher net gains in target villages in 2020 compared with non-target villages, possibly due to reduced severity of disease and improved awareness on FMD and general livestock health. The findings of this study will help improve strategies for sustainable and efficient FMD control in Lao PDR, while the challenges and importance of gaining participation by smallholders are highlighted.

Oral health behaviour of urban and semi-urban schoolchildren in the Lao PDR.

OBJECTIVE: To describe the oral health related knowledge, behaviour, and attitude towards health of 12-year old Lao schoolchildren; analyse how health risk factors relate to socio-demographic background; and determine the relative effect of living conditions on health and risk behaviour. METHODS: Cross sectional study of 12-year old schoolchildren chosen by multistage sampling to fit the objective of the study. The final sample comprised 621 children of 2nd grade of secondary schools in Vientiane, Lao Peoples Democratic Republic. Data were collected by structured questionnaire covering behaviour, attitudes and knowledge related to oral and general health and perception of own health. RESULTS: 69% of the children reported toothache during the previous 12 months and 38% reported school absenteeism due to toothache. Nevertheless, 77% stated frequent brushing and 91% the use of fluoridated toothpaste. Only 29% reported dental visits for this period while 42% had never seen a dentist. Fear of pain, cost and distance were stated as barriers for dental visits. Knowledge on caries prevention was high, aetiology of oral disease less known, and intake of hidden sugar surprisingly frequent. Socio-economic position and attitude towards health were important predictors for oral health behaviour and risk behaviour. CONCLUSIONS: Despite regular tooth brushing practice and widespread use of fluoridated toothpaste school absenteeism due to toothache is high. Significant socio-demographic gradient exists in risk factors for oral health. To reduce oral health inequality systematic oral health promotion should be implemented through the existing school health platform strengthening healthy behaviour and focussing on risk factors for oral as well as general health.

High seroprevalence of Foot and Mouth Disease in Laos: Call for nationwide vaccination campaigns and disease surveillance.

Foot and mouth disease (FMD) virus remains enzootic in Lao People's Democratic Republic (Lao PDR) due to insufficient control measures, including low vaccination coverage. We assessed virus epidemiology and evaluated knowledge, attitude and practice of Lao farmers and animal health stakeholders towards FMD to support politics in devising evidence-based control measures. Sera were collected from 972 domestic ruminants in three provinces of Lao PDR: Vientiane Capital, Vientiane and Xiengkhouang provinces. Seroprevalence of antibodies directed against non-structural proteins of FMD virus was assessed using a commercial ELISA. Positive sera were further characterized by detecting antibodies directed against the structural proteins of FMD serotypes O, A and Asia 1. Information about farm management, biosecurity practices, livestock trade, and past FMD outbreaks was obtained. Overall 35% (340/972) of the ruminants had antibodies against FMD virus with a similar seroprevalence in each province. Seroprevalence depended significantly on the ruminant species (p < .001): 61% of buffaloes, but only 41% of cattle and 15% of goats were seropositive. While antibodies against FMD serotype Asia 1 were absent, 87% (297/340) of the seropositive animals had antibodies against FMD serotype O and 32% (110/340) against FMD serotype A. Many seropositive animals (31%) had antibodies against both serotypes O and A. The majority of the farmers could name the symptoms of FMD and the susceptible animal species. Although many had likely observed FMD outbreaks in their herd and were aware of FMD vaccines, only few vaccinated their animals. This study confirms that FMD remains enzootic in at least three provinces of Lao PDR where vaccination coverage is low. It also shows the relevance of nationwide active and passive disease surveillance, as well as of vaccination campaigns using bivalent FMD vaccines and targeting all susceptible animal species.

Early childhood caries and related factors in Vientiane, Lao PDR.

The objectives of this study were to determine the prevalence of early childhood caries and the oral health status in children aged 36-47 months in Vientiane, the capital city of Lao PDR. This study also aimed to assess the feeding practices, snack consumption, oral hygiene practices, and dental visits of children at this age. A total of 400 children were selected for oral examination and their caretakers were interviewed. The results showed the prevalence of dental caries was 82% with mean decayed, missing and filled teeth (dmft) +/- SD 5.5 +/- 4.3 teeth. No missing teeth were found (mt = 0), and the mean filled teeth (ft) was only 0.02. The teeth most affected by dental caries were the upper right and left central incisors, followed by the upper right and left lateral incisors, lower molars, upper molars, upper canines, lower canines and lower central incisors. The least affected were the lower right and left lateral incisors. Factors that affected dmft were tooth brushing frequency, brushing with parental assistance or supervision, time brushing started, feeding pattern, and the type of milk, candy and sweet beverages consumption. It can be concluded that children in the studied area had a high prevalence of caries and a high level of severity. Thus, oral health care programs should be promoted in Vientiane.

The oral health of children in a rural area of the Lao People's Democratic Republic.

The lack of information on oral health in Laos makes it difficult to estimate the need and methods for preventing oral disease. This study identified problems concerning the oral health of Lao children. The study subjects were 59 school children who lived in Pakkading District. Dental caries, gingivitis malocclusions, temporomandibular joint (TMJ) disorders, dental plaque, and calculus were examined. We observed an average of 1.6 decayed, missing, and filled teeth (DMFT) and 4.1 decayed and filled deciduous teeth (dft) per child. 25.4% had gingivitis scores from 16 to 20 on the papillary, marginal, and attached (PMA) index; 29.6% had one or more occlusal abnormality; and 0% had signs of TMJ disorders. 93.5% of the children had at least one buccal or lingual tooth surface with plaque covering more than two thirds of the surface; 32.6% had dental calculus. Oral health promotion programs for children should prioritise prevention and treatment of caries. It is likely that the high rate of gingivitis in Lao children is due mainly to unsuccessful plaque control in daily life. In addition to descriptive epidemiological studies of dental diseases in other areas, the influence of sociological and behavioural factors on oral health should be analyzed epidemiologically to promote child health.

Oral health and the impact of socio-behavioural factors in a cross sectional survey of 12-year old school children in Laos.

BACKGROUND: In recent decades low-income countries experienced an increasing trend in dental caries among children, particularly recorded in 12-year olds, which is the principal WHO indicator age group for children. This increases the risks of negative affects on children's life. Some data exist on the oral health status of children in low-income countries of Southeast Asia. However, information on how oral health is associated with socio-behavioural factors is almost not available. The aims of this study were to: assess the level of oral health of Lao 12-year-olds in urban and semi-urban settings; study the impact of poor oral health on quality of life; analyse the association between oral health and socio-behavioural factors; investigate the relation between obesity and oral health. METHODS: A cross sectional study of 12-year old schoolchildren chosen by multistage random sampling in Vientiane, Lao P.D.R (hereafter Laos). The final study population comprised 621 children. The study consisted of: clinical registration of caries and periodontal status, and scores for dental trauma according to WHO; structured questionnaire; measurement of anthropometric data. Frequency distributions for bi-variate analysis and logistic regression for multivariate analysis were used for assessment of statistical association between variables. RESULTS: Mean DMFT was 1.8 (SEM = 0.09) while caries prevalence was 56% (CI95 = 52-60). Prevalence of gingival bleeding was 99% (CI95 = 98-100) with 47% (CI95 = 45-49) of present teeth affected. Trauma was observed in 7% (CI95 = 5-9) of the children. High decay was seen in children with dental visits and frequent consumption of sweet drinks. Missed school classes, tooth ache and several impairments of daily life activities were associated with a high dD-component. No associations were found between Body Mass Index (BMI) and oral health or common risk factors. The multivariate analyses revealed high risk for caries for children with low or moderate attitude towards health, a history of dental visits and a preference for drinking sugary drinks during school hours. Low risk was found for children with good or average perception of own oral health. High risk for gingival bleeding was seen in semi-urban children and boys. CONCLUSION: Although the caries level is low it causes considerable negative impact on daily life. School based health promotion should be implemented focussing on skills based learning and attitudes towards health.

Oral health behavior of children and guardians' beliefs about children's dental caries in Vientiane, Lao People's Democratic Republic (Lao PDR).

Dental caries is considered a major health problem among schoolchildren in Lao People's Democratic Republic (Lao PDR). According to Health Belief Model (HBM)-based research, children's oral health behavior can be determined by their guardians' beliefs. This study aimed to describe children's oral health behavior and its association with childhood dental caries, as well as to assess associations between children's tooth-brushing behavior and guardians' beliefs in an urban area of Lao PDR, using HBM. Data were collected from ten primary schools in the Sisattanak district, the Vientiane capital, between 2013 and 2014. Ten dentists with the help of dental hygienists and schoolteachers conducted dental health check-ups at the schools that diagnosed dental caries based on visual inspection. They also conducted a questionnaire-based survey with the schoolchildren's guardians to collect data including socio-economic and demographic information, their children's oral health behavior, and guardians' beliefs derived from HBM, including perceived susceptibility to and perceived severity of child dental caries, perceived benefit of and perceived barrier to child's tooth brushing, and self-efficacy in making their children brush their teeth twice daily. A mixed-effects logistic regression model assessed the association between dental caries and children's oral health behavior and between children's tooth-brushing behavior and guardians' beliefs. Data from 1161 of 1304 (89.0%) children registered at the schools were used. The prevalence of dental caries was 82%. Children who brushed their teeth ≥ twice/day were significantly less likely to have dental caries than those brushing once or seldom (OR: 0.64, 95% CI: 0.45 to 0.91). The number of children who brushed twice daily also significantly increased with the increased level of guardians' self-efficacy (OR: 2.14, 95% CI: 1.91 to 2.41). In conclusion, childhood dental caries was associated with daily tooth brushing. Children's tooth-brushing behavior was associated with guardians' self-efficacy in making their children brush twice daily.

Foot and mouth disease in the Lao People's Democratic Republic: I. A review of recent outbreaks and lessons from control programmes.

Foot and mouth disease (FMD) causes sporadic disease outbreaks in the Lao People's Democratic Republic (Lao PDR). As the Lao PDR is a major thoroughfare for transboundary animal movements, regular FMD outbreaks occur, causing economic hardship for farmers and their families. In this review of the recent history of FMD in the Lao PDR between 1997 and 2006, the authors examine the virological and epidemiological aspects of the disease and appropriate control measures, including the distribution of outbreaks, causative serotypes and the molecular epidemiology of the viruses, as well as large-scale vaccination programmes. The dominant serotype, type O, was reported every year from 1998 to 2005. The majority of outbreaks occurred in Vientiane Capital (n = 42; 28%) and the highest number of outbreaks were reported in cattle (n = 94; 61%); followed by buffalo (n = 41; 27%) and pigs (n = 18; 12%). All type A outbreaks occurred in cattle. Type Asia 1 outbreaks were reported in the central provinces around Vientiane Capital between 1996 and 1998.

Foot and mouth disease in the Lao People's Democratic Republic: II. Seroprevalence estimates, using structured surveillance and surveys of abattoirs.

An examination of the seroprevalence of foot and mouth disease (FMD) virus was conducted in the Lao People's Democratic Republic (Lao PDR) from 1996 to 2005, using structured surveillance and abattoir-based studies. Under structured surveillance, seropositivity ranged from 65.7% (Vientiane Capital, 1996) to 3% (Houaphan, 2005) for cattle and buffalo; and from 2.8% (Vientiane Capital, 1998) to 0% in separate studies of pigs. In each study, species composition was significantly associated with seroprevalence rates. For abattoir surveys, the majority of samples (60.5%) came from Vientiane Capital (33.0%), Savannakhet (14.0%) and Champasak (13.5%) provinces. The overall proportion of animals testing positive for the presence of antibodies against the FMD virus was 18.7% (ranging from 50.8% in Vientiane Province to 1% in Phongsali). Generally, antibodies against serotype O were the most prevalent. Cattle and buffalo that tested as seropositive were significantly older than the seronegative animals (p < 0.00005). The overall proportional seropositivity was significantly different for different species, as was the case with the antibodies against serotypes O, A and Asia 1. Some 22% of cattle, 55% of buffalo and 23% of pigs demonstrated seropositivity but this varied significantly between provinces.

Risk factors for emergence of exotic foot-and-mouth disease O/ME-SA/Ind-2001d on smallholder farms in the Greater Mekong Subregion.

Foot-and-mouth disease (FMD) is a significant endemic transboundary animal disease in Lao People's Democratic Republic (Lao PDR) and throughout the Greater Mekong Subregion (GMS). The disease has been shown to perpetuate the cycle of smallholder poverty through reduced animal production, plus limitations on market access for trading in livestock and their products. Despite significant national and multilateral efforts to control FMD over the past two decades, endemic FMD viruses (FMDVs) continue to circulate in Lao PDR. Further, the threat from new and emerging FMDVs is increasing as transboundary movements in the region intensify in response to increasing regional demand for meat. Although the economic impacts of FMD on smallholder farmers in Lao PDR are significant, studies investigating household-level risk factors for FMD are lacking. Following an outbreak of a novel FMDV (O/ME-SA/Ind2001d) in Lao PDR in 2015, a questionnaire and serological study were conducted in Naxaythong District to identify household-level risk factors associated with this outbreak, as well as endemic circulating viruses in the outbreak area. Data were analysed using a multivariable generalised estimating equation (GEE) model with a logit link function and associations were calculated as odds ratios (OR) with 95% confidence intervals (CI95%). After adjusting for other variables, the practice of quarantining new livestock for a minimum of two weeks prior to introduction to a herd was found to be a significant protective factor during the 2015 outbreak (OR 0.225, CI95% [0.06, 0.88], p-value 0.003). In addition, households owning one or more animals with titres to the non-structural proteins of FMDV, indicating prior infection, had 5.5 times the odds (CI95% [6.16, 49.11], p-value <0.001) of sharing communal grazing land with neighbouring villages. These findings indicate that implementing basic on-farm biosecurity and improved husbandry measures to minimise FMDV circulation at the household level are important and reinforce the need to enhance the education of smallholder farmers in infectious disease control.

Household Financial Status and Gender Perspectives in Determining the Financial Impact of Foot and Mouth Disease in Lao PDR.

The socioeconomic impacts of foot and mouth disease (FMD) during 2011-12 outbreaks on large ruminant smallholders in Laos were investigated, including examination of data on gender, household financial status and farmer husbandry practices. A mix of participatory tools and survey questionnaires at the village and household level, respectively, were conducted, involving individual farmer interviews (n = 124) and group meetings with village elders to establish criteria for classification of household financial status as being 'poor, medium or well off' according to rice sufficiency, assets and household incomes. FMD-attributable financial losses were determined by inclusion of losses due to: mortality, morbidity and costs of treatments. The estimated mean financial losses due to FMD were USD 436 (±92) in the 'poor' and USD 949 (±76) in the 'well off' household categories (P < 0.001), being 128% and 49% of income from the sale of large ruminants, respectively. Variation in financial losses reflected differences in morbidity, farmer husbandry practices including frequency of observation of animals and thus recognition of FMD and choice of treatments. Of concern were adverse financial impacts of treatment especially where antibiotics were used; delays in reporting of FMD cases after observation of signs (mean of 2 days); admission that 10% of farmers had sold FMD-affected livestock; and that 22% of respondents claimed their large ruminants were cared for by females. The findings confirm that FMD has the most severe financial impact on poorer households and that females have a significant role in large ruminant production. It is recommended that livestock extension activities promote the benefits of prevention rather than treatment for FMD and encourage participation of women in biosecurity and disease risk management interventions including rapid reporting and regulatory compliance, particularly with animal movement controls and other biosecurity practices that reduce the negative impacts of FMD on regional food security and poverty reduction in rural communities.

Caries risk profiles of 12-13-year-old children in Laos and Sweden.

PURPOSE: To analyse caries risk factors of 12-13-year-old children living in Laos, using the computer program Cariogram to illustrate the caries risk profile. In addition, to compare the results with a study performed in Sweden. MATERIALS AND METHODS: One hundred Laotian and 392 Swedish children were included. Interviews were performed to obtain information on diet intake and fluoride use. Saliva was analysed for mutans streptococci, lactobacilli and secretion rate/buffering capacity. Oral hygiene was assessed using the Silness and Löe criteria. Caries prevalence was recorded according to WHO. The data were entered into the Cariogram to determine each child's caries risk, expressed as 'the chance of avoiding caries'. The children were divided into five risk groups. RESULTS: Mean DMFT level of the Laotian children was 4.61 +/- 2.95 and 1.38 +/- 1.97 in the Swedish group. For the risk factors plaque amount, frequency of food intake, saliva secretion rate, buffering capacity and fluoride, the Laotian children had significantly less favourable values compared to the Swedes. Only 6% of Laotian children belonged to the Cariogram low risk group versus 40% of the Swedish children. The mean DMFT for the five Cariogram groups was (from low to high risk) 0.00, 3.00, 3.56, 5.66, 6.11 for the Lao children and 0.31, 1.39, 2.56, 3.03, 2.91 for the Swedish ones. The mean chance of avoiding caries was 37.3% for the Laotians and 69.2% for the Swedish children (p < 0.001). CONCLUSION: According to the 'opinion' of the Cariogram, the Laotian children demonstrated significantly higher caries risk than Swedish children.