Risk Factors of Preterm Delivery in the Lao PDR: Hospital-Based Matched Case-Control Study.

OBJECTIVE: To describe the risk factors among mothers in four central hospitals and two provincial hospitals in the Lao PDR, a lower-middle-income country in Southeast Asia. METHOD: The study used a hospital-based matched case-control design study. Purposive sampling was used to select 320 mothers (80 cases and 240 controls) from the six hospitals. Cases were mothers who had delivered a live newborn between 28 and 36 weeks and 6 days, while controls were mothers who had delivered a live newborn within 37 and 40 weeks. Data were collected through a review of medical records and face-to-face interviews using a structured questionnaire. Data were entered into EPI info (Version 3.1) then exported to the STATA programme (Version 14) for univariate and conditional multiple logistic regressions to identify risk factors for PTD at p ≤ 0.05. RESULTS: The mean maternal age of cases and controls was 25.2 (SD = 5.33) and 25.8 (SD = 4.37), respectively. In the multivariate analysis, factors with statistically significant relationships with PTD were the mother's religion (AOR: 3.01; 95% CI 1.24-7.26), the number of antenatal care visits (AOR: 3.39; 95% CI 1.6-7.18), having a pre-pregnancy maternal weight of less than 45 kg (AOR: 3.05; 95% CI 1.66-10.5), having had a premature preterm rupture of the membrane (AOR: 7.13; 95% CI 2.44-20.8) and vaginal bleeding during pregnancy (AOR: 6.89; 95% CI 3.02-15.73). CONCLUSIONS FOR PRACTICE: Improving capacity of the Laotian health system to provide quality ANC and increasing the number of ANC contacts is critical. This requires context specific strategies that also address the socio-economic factors, such as access to a nutritious diet, that contribute to PTD.

Perceptions and understandings of pregnancy, antenatal care and postpartum care among rural Lao women and their families.

BACKGROUND: Lao People's Democratic Republic (Lao PDR) has the highest maternal mortality rate (MMR) and infant mortality rate (IMR) due to traditional practice and beliefs on pregnancy, delivery and postpartum. The objective of this study was to get a better understanding of cultural beliefs and practices surrounding pregnancy, ANC and postpartum care among rural women in Lao PDR. METHODS: Eight focus group discussions and 52 interviews were carried out with delivered women, husbands, mothers, traditional birth attendants, head villagers, Lao Women's Union members and healthcare workers, in Khammouane and Champasack provinces in Lao PDR. In order to accurately grasp participants' perceptions and understandings, content analysis was used to analyze the transcripts. RESULTS: Most women in the study claimed to have attended ANC, but participants also explained that it was unnecessary to attend ANC and give birth at a clinic if the woman felt healthy. Factors that discouraged ANC attendance and giving birth at clinics included: time and money constraints; the perceived necessity of giving birth on a "hot bed"; the need for "mother-roasting" after giving birth; the belief that preparing for a birth was a bad omen for the birth; the belief that colostrum is unhealthy for the newborn child; and the preference for cutting the umbilical cord with a piece of sharpened bamboo. CONCLUSIONS: Harmful cultural practices such as discarding colostrum should be discouraged; beneficial practices such as family involvement in birthing and keeping a mother warm after birth could be integrated into biomedical practice. Given the prevalence and importance of the cultural understandings we have described in this study, it is clear that proposed changes in cultural practices need to be addressed with sensitivity and that community stakeholders and trusted leaders will need to be involved.

Perceptions and acceptability of pictorial health warning labels vs text only--a cross-sectional study in Lao PDR.

BACKGROUND: In Lao PDR, health warnings were first introduced with printed warning messages on the side of the cigarette package in 1993 and again in 2004. Lao PDR same year ratified the Framework Convention on Tobacco Control (WHO FCTC) but has not yet implemented pictorial health warnings. This paper aims to examine the perception and opinion of policymakers on "text-only" and "pictorial" health warnings and to understand lay people's perceptions on current health warnings and their opinions on the recommended types of health warnings. METHODS: A combination of quantitative and qualitative methods were used in this cross-sectional study conducted in 2008. A purposive sample of 15 policymakers, and a representative sample of 1360 smokers and non-smokers were recruited. A range of different areas were covered including consumer attitudes towards current and proposed cigarette package design, views on health warning messages on the flip/slide and inserts, and views on the relative importance of the size, content and pictures of health warning messages. Descriptive statistics and content analysis were used. RESULTS: Policy makers and survey respondents said that the current health warning messages were inappropriate, ineffective, and too small in size. All respondents perceived pictorial health warnings as a potentially powerful element that could be added to the messages that can communicate quickly, and dramatically. The majority of policymakers and survey respondents strongly supported the implementation of pictorial health warnings. The non-smokers agreed that the graphic pictorial health warnings were generally more likely than written health warnings to stimulate thinking about the health risks of smoking, by conveying potential health effects, increasing and reinforcing awareness of the negative health effect of smoking, aiding memorability of the health effects and arousing fear of smoking among smokers. CONCLUSIONS: The study suggested that current warnings are too small and that content is inadequate and designed to be hidden on the side pack. These findings are in line with FCTC's requirements and provide strong support for introducing pictorial warning labels also in Lao PDR. Furthermore, the awareness of Members of Parliament about tobacco control measures holds promise at the highest political level.

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). METHODS: The study collected data for the identified indicators in 2011 from Xiengkhouang and Houaphanh provinces in the Lao People's Democratic Republic (PDR). The data came from health centres (N = 109), sub-districts (N = 26) and district health offices (N = 16). Core indicators were calculated using numerators and denominators from the different data sources at the district and health centre level and standardized statistical tests performed. RESULTS: The study revealed that data for the six indicators were either not available or not complete in the service logbooks or registers in most of the health centres. Furthermore, few health centres kept the data for up to five years, often destroying it once the report had been sent to the district health office. In addition, there was limited numerator consistency between the different data sources. CONCLUSION: Data on the six indicators collected and reported in the public health system across the two provinces lacked completeness, accuracy and consistency. To improve the quality of data, there is a need to train health centre staff in data collection and recording as well as ensuring there is adequate monitoring and supervision. A uniform national standardized form is also necessary with findings shared with district health offices and centres. Additionally, staff should be encouraged to own and value local data.

Awareness and attitudes towards emergency contraceptive pills among young people in the entertainment places, Vientiane City, Lao PDR.

BACKGROUND: Emergency Contraception is not officially available to the public sector in Laos. The potential of emergency contraception to prevent unwanted pregnancies is well documented in developed countries, but in Laos no studies of ECPs exist. This study aimed to assess knowledge of and attitudes towards emergency contraceptive pills (ECPs) in Vientiane, the capital city of the Lao PDR. METHODS: A cross-sectional survey was conducted among 500 young adults in entertainment venues by using the convenience sampling between May to July, 2007. Data were obtained through face-to-face interview. Participants were asked about socio- demographic characteristics, knowledge, attitudes related to ECPs, and source of information about ECPs. Data analysis was performed with chi-square test and logistic regression (p < .05). RESULTS: Only 22.4 percent of respondents had heard of ECPs and of these only 17.9 percent knew the correct time-frame for effective use. Most of the respondents (85%) agreed on the need for ECPs to be available in Laos and 66.8 percent stated that they would use them should the need arise, if they were available. Among those who said they would not use ECPs, 63.8 percent were concerned about possible health effects, or other side effects. Awareness of ECPs was associated with increasing age (OR = 2.78, p = .025) and male sex (OR = 2.91, p = .010). CONCLUSIONS: There is needed to provide effective health education about the method, timing of use, and how to obtain ECPs through both informal, peer channels, and also through formal channels such as health care providers.

Adherence to antiretroviral therapy (ART) among people living with HIV (PLHIV): a cross-sectional survey to measure in Lao PDR.

RATIONALE: Since 2001, antiretroviral therapy (ART) for people living with HIV (PLHIV) has been available in the Lao People's Democratic Republic (PDR). A key factor in the effectiveness of ART is good adherence to the prescribed regimen for both individual well-being and public health. Poor adherence can contribute to the emergence of drug resistant strains of the virus and transmission during risky behaviors. Increased access to ART in low-income country settings has contributed to an interest in treatment adherence in resource-poor contexts. This study aims to investigate the proportion of adherence to ART and identify possible factors related to non-adherence to ART among people living with HIV (PLHIV) in Lao PDR. METHODS: A cross-sectional study was conducted with adults living with HIV receiving free ART at Setthathirath hospital in the capital Vientiane and Savannakhet provincial hospitals from June to November 2011. Three hundred and forty six PLHIV were interviewed using an anonymous questionnaire. The estimation of the adherence rate was based on the information provided by the PLHIV about the intake of medicine during the previous three days. The statistical software Epidata 3.1 and Stata 10.1 were used for data analysis. Frequencies and distribution of each variable were calculated by conventional statistical methods. The chi square test, Mann-Whitney test and logistic regression were used for bivariate analyses. Multiple logistic regression analysis was conducted to determine the predictors of non-adherence to ART. A p-value < 0.05 was considered to indicate statistical significance. RESULTS: Of a total of 346 patients, 60% reported more than 95% adherence to ART. Reasons for not taking medicine as required were being busy (97.0%), and being forgetful (62.2%). In the multivariate analysis, educational level at secondary school (OR=3.7, 95% CI:1.3-10.1, p=0.012); illicit drug use (OR=16.1, 95% CI:1.9-128.3, p=0.011); dislike exercise (OR=0.6, 95% CI:0.4-0.9, p=0.028), and forgetting to take ARV medicine during the last month (OR=2.3, 95% CI:1.4-3.7, p=0.001) were independently associated with non-adherence. CONCLUSIONS: Non-adherence to ART was associated with individual factors and exposure to ART. Priority measures to increase adherence to ART should aim to intensify counseling and comprehensive interventions, such as guidance for PLHIV on medication self-management skills, tailoring the regimen to the PLHIV life style, and improving adherence monitoring and health care services.

Respiratory illness healthcare-seeking behavior assessment in the Lao People's Democratic Republic (Laos).

BACKGROUND: Respiratory illness (RI) remains a public health problem in Laos, but little is known about the overall burden and people's healthcare-seeking behavior for RI. Understanding the burden of RI and community patterns of healthcare-seeking behavior would provide better guidance for Lao public health program and policy planners to improve RI public health practice, surveillance systems, and prevention strategies. METHODS: A quantitative and qualitative survey was conducted in 14 randomly selected villages of two purposively selected peri-urban and two rural provinces in Laos. A pre-designed and pre-tested questionnaire was used to collect information on RI in household members (defined as new fever with cough and/or sore-throat in the absence of other diagnoses during the preceding 30 days) from all heads of household in each village. Sixteen focus group discussions were conducted to obtain more information to support the quantitative survey. RESULTS: Among 1,751 households (9,114 people) studied, 3.5% (317/9,114) had experienced RI (fever, cough, and/or sore-throat) in the 30 days before the survey [6.2% in rural and 2.4% in peri-urban areas (p<0.001)]. The percentage of RI among persons aged≥15 years was 2.7%, 3.7% for those aged 5-14 years, and 8.2% for children<5 years (p<0.001). Of all sick persons, 71% sought treatment [94% in peri-urban and 48% in rural areas (p<0.001)] and 31.5% of them self-medicated [55.5% in peri-urban and 29% in rural areas (p<0.001)]. Sick people in peri-urban areas preferred to chose private clinics and pharmacies as their first treatment option while in rural areas they frequently consulted with village health volunteers and visited health centres as their first choice. The qualitative study suggests that distance, costs of care, and service availability are the most important determinants of seeking healthcare. CONCLUSIONS: The RI burden and healthcare-seeking behavior are different between rural and peri-urban areas of Laos and this is probably due to the differences in environmental and hygienic conditions, health service availability and socio-economic status between the two areas. Therefore strategies for healthcare service improvement may also need to differ between the two areas.

Reasons rural Laotians choose home deliveries over delivery at health facilities: a qualitative study.

BACKGROUND: Maternal mortality among poor rural women in the Lao People's Democratic Republic (Lao PDR) is among the highest in Southeast Asia, in part because only 15% give birth at health facilities. This study explored why women and their families prefer home deliveries to deliveries at health facilities. METHODS: A qualitative study was conducted from December 2008 to February 2009 in two provinces of Lao PDR. Data was collected through eight focus group discussions (FGD) as well as through in-depth interviews with 12 mothers who delivered at home during the last year, eight husbands and eight grandmothers, involving a total of 71 respondents. Content analysis was used to analyze the FGD and interview transcripts. RESULTS: Obstacles to giving birth at health facilities included: (1) Distance to the health facilities and difficulties and costs of getting there; (2) Attitudes, quality of care, and care practices at the health facilities, including a horizontal birth position, episiotomies, lack of privacy, and the presence of male staff; (3) The wish to have family members nearby and the need for women to be close to their other children and the housework; and (4) The wish to follow traditional birth practices such as giving birth in a squatting position and lying on a "hot bed" after delivery. The decision about where to give birth was commonly made by the woman's husband, mother, mother-in-law or other relatives in consultation with the woman herself. CONCLUSION: This study suggests that the preference in rural Laos for giving birth at home is due to convenience, cost, comfort and tradition. In order to assure safer births and reduce rural Lao PDR's high maternal mortality rate, health centers could consider accommodating the wishes and traditional practices of many rural Laotians: allowing family in the birthing rooms; allowing traditional practices; and improving attitudes among staff. Traditional birth attendants, women, and their families could be taught and encouraged to recognize the signs of at-risk pregnancies so as to be able to reach health facilities on time.

Health policymakers' knowledge and opinions of physicians smoking and tobacco policy control in Lao PDR.

BACKGROUND: In 2007, a regulation on smoke-free health facilities and institutions was adopted by the Lao government. Little is known about health policymakers' knowledge and opinions regarding tobacco policy control, including physicians' behaviour. This paper aims to describe the knowledge of Lao health policymakers and their opinions regarding physicians tobacco use and national smoking policy control. METHODS: In 2007, we made a qualitative explorative study with data from a purposive sample of 18 key informants through semi-structured, face-to-face interviews. The key informants, who were heads of departments, directors of hospitals and directors of centres, mainly worked at the national level, and some provincial levels. Content analysis was used. RESULTS: Policymakers perceived the inadequate implementation of a smoke-free regulation and policy as being a barrier and that the general public may not accept physicians smoking, since they are regarded as role models. Most of the respondents mentioned that regulations or laws related to control of smoking in health institutions are available in Laos, but they lacked detailed knowledge of them probably because regulations as well as the smoke-free policy documents were not widely disseminated. The respondents agreed that anti-smoking education should be integrated in the training curricula, especially in the medical schools, and that the provision of counselling on health consequences from smoking and methods of smoking cessation was important. CONCLUSION: This study contributes to tobacco policy evidence and to knowledge regarding factors related to the uptake of evidence into policymaking. Dissemination and implementation of a tobacco control policy nationally, and integration of tobacco cessation training programs in the curricula were found to be productive approaches for improvement.

Defining and redefining harm reduction in the Lao context.

The response to drug use in Laos has focused on reducing opium supply (supply reduction) and rates of drug use (demand reduction). However, recently there is increased interest among government counterparts to discuss and develop broader responses to injecting drug use (IDU) including the introduction of harm reduction programs. The concept of harm reduction has just been introduced to Lao PDR and as yet there is no agreement on a definition of the concept. We highlight here a range of issues that remain controversial in Lao PDR in the HIV, drug use and harm reduction discourse, the definition of 'harm reduction' and related terms; and the scope of harm reduction.This was a qualitative study, consisting of in-depth interviews with 27 law enforcement and 8 health officers who work in the fields of HIV and/or drug control about their understanding of HIV related to drug use, and concepts of harm reduction. Content analysis was performed to identify the coding, categories and themes.We found that law enforcement officers in particular had limited understanding about harm reduction and the feasibility and appropriateness of harm reduction services in the Lao context.Harm reduction should be a core element of a public health response to HIV where drug use and IDU exists. Recommendations include the necessity of increasing the awareness of harm reduction among law enforcement officers and providing appropriate evidence to support the needs of harm reduction policy and programs. HIV prevention and treatment strategies should be integrated within existing social and cultural frameworks, working with the task force for HIV/IDU and other government counterparts.

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.

Comparison of Nutrient Intake in Lao PDR by the Korean CAN-Pro and Thailand INMUCAL Analysis Programs.

A computer-based nutritional analysis program can help to identify the nutritional status of people and provide information for nutritional counseling, nutrition education, diet planning, and menu development. Although computer-based nutritional analysis has been conducted since the 1960s in developed countries, in developing countries nutritional analysis programs either do not exist or need improving. This study tests two analysis programs developed by different countries to compare the nutrition status data calculated by two different analysts to highlight the importance of developing an appropriate nutrition analysis tool. An interview-administered 24-h dietary recall method was conducted with 100 adults aged 40∼59 years in Vientiane, Laos. Analysts from Korea and Laos, respectively, calculated nutrient intake using the Institute of Nutrition, Mahidol University CALculation (INMUCAL) nutritional analysis program (Bangkok, Thailand). Nutrient intake was also compared using two different analysis tools, INMUCAL and computer aided nutrition-al analysis program (CAN-Pro) 5.0 software (Seoul, Korea). The average nutrient intake calculated by the different analysts using INMUCAL were not significantly different. Furthermore, macronutrient intake calculated by CAN-Pro 5.0 and INMUCAL did not significantly differ, aside for intake of iron, thiamin, and vitamin C. Nutrient intake calculated by one analysis program differed from those calculated by a different program in Laos. Therefore, it is necessary to develop an appropriate nutritional analysis program that reflects the diet behavior and food culture in Laos and to understand the nutritional status of Laotians.

Policy maker and provider knowledge and attitudes regarding the provision of emergency contraceptive pills within Lao PDR.

BACKGROUND: The Ministry of Health (MOH) launched the National Reproductive Health Policy in 2005, which included recommendations regarding the use of emergency contraceptive pills (ECP). However, ECP have not yet been introduced officially in the public sector of the Lao PDR. Thus, their availability is limited. Understanding the knowledge of ECP and attitudes about their provision, barriers to use, and availability among health providers and policy makers is essential to successfully incorporate ECP into reproductive health services. METHODS: Qualitative research methods using in-depth interviews were employed to collect data from policy makers and health providers (auxiliary medical staff, nurses, and medical doctors). Altogether, 10 policy makers, 22 public providers, and 10 providers at private clinics were interviewed. Content analysis was applied to analyze the transcribed data. RESULTS: The majority of policy makers and health care providers had heard about ECP and supported their introduction in the public sector. However, their knowledge was poor, many expressed inconsistent attitudes, and their ability to meet the demand of potential users is limited. CONCLUSIONS: There is a need to train health providers and policy makers on emergency contraception and improve their knowledge about ECP, especially regarding the correct timing of use and the availability of methods. In addition, the general public must be informed of the attributes, side effects, and availability of ECP, and policy makers must facilitate the approval of ECP by the Lao Food and Drug Administration. These interventions could lead to increased access to and demand for ECP.

Pregnancy health literacy among teenagers in Kaysone district, Savannakhet Province, Lao PDR.

BACKGROUND: Pregnancy health literacy (PHL) among teenagers is considered a major protective factor for teenage pregnancy. In Lao PDR, 18% of girls aged 15-19 have begun childbearing and 15% of maternal deaths occur to teenage girls, particularly in rural areas. OBJECTIVE: The aim of this study was to describe PHL and its related factors among teenagers in Kaysone district. METHOD: This was a cross-sectional study conducted at Oudomvilay and Kheuakhaokat in Kaysone district in January 2019. The Teenage Pregnancy Health Literacy (TPHL) score was collected via face to face interviews covering 33 items with 262 adolescents. Calculation of the TPHL index score was based on the European Health Literacy Survey (HLS-EU) index formula. The TPHL index was also based on the HLS-EU standard level and descriptive statistics were used to explain the score and levels. Descriptive analyses were performed to analyse the individual, family, peer and school variables and to investigate level of TPHL and linear regression was used to identify factors related to TPHL. RESULTS: The overall score for TPHL was a mean of 27/50. Most (60%) of the adolescents had problematic TPHL levels and only 0.4% had excellent TPHL levels. TPHL was positively and significantly associated with living in urban areas (ß = 2.42; p = 0.002), higher education (ß = 2.93; p = 0.004), schooling (ß = 0.96; p = 0.018), being single (ß = 2.9; p = 0.029) and attending classes where sex education content was included (ß = 4.72; p < 0.001). CONCLUSION: Low TPHL scores show the importance of improving sex education for adolescents as a means of increasing TPHL for better health outcomes in Lao PDR.

A model for improving physician performance in developing countries: a three-year postgraduate training program in Laos.

The Faculty of Medical Sciences of the National University of Laos, in partnership with Health Frontiers, an American nonprofit organization, Case Western Reserve University of Cleveland, Ohio, and Khon Kaen University of Khon Kaen, Thailand, administer a postgraduate internal medicine training program for Lao physicians. Begun in 2001, the program admits six participants per year; participants complete clinical rotations in three hospitals in Vientiane, Laos, as well as one other clinical site. The goal of the program is to prepare a core group of local physicians to deliver healthcare, and train others according to an international standard of care. The program has two exceptional features. First, the vast majority of the training takes place in Laos. This avoids the "brain drain" that can occur when nationals of developing countries train abroad. In addition, because the training uses personnel, facilities, and technology available locally, graduates are better prepared to serve the needs of the Lao people. Second, the partnership is an all-volunteer model, committed to a long-term undertaking. American-trained specialists who live in Laos are available to work with the participants on a daily basis. Participants have a long period of time to acquire, reinforce, and be tested in new knowledge and benefit from learning from American colleagues who model an evidence-based approach to medical care, while still working in local conditions. As more Lao physicians receive this level of training, the program will become locally sustainable and help break a cycle of dependency on foreign expertise within the Lao health care sector. Preliminary results suggest that the program is succeeding, and could be replicated elsewhere.

Cross-sectional survey: smoking among medical, pharmacy, dental and nursing students, University of Health Sciences, Lao PDR.

OBJECTIVES: To investigate the prevalence of and attitudes to smoking among third year medical, pharmacy, dentistry and nursing students in Lao People's Democratic Republic (PDR). DESIGN: A cross-sectional survey conducted among third year university level, health professional students. The survey used a self-administered questionnaire which was originally developed by WHO, and modified to suit the setting. SETTING: The setting was the University of Health Sciences in Vientiane, the capital of Lao PDR. Participants were recruited from the Faculties of Medicine, Pharmacy, Dentistry and Nursing. At the time of the survey, 521 third year students were enrolled. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was prevalence of current cigarette smoking and other tobacco use. Smoking status was categorised as: current smoker, ex-smoker and non-smoker with current smokers defined as those who had smoked cigarettes or used other tobacco on one or more days during the previous 30 days. RESULTS: In total, 506 respondents completed the questionnaire, giving a response rate of 97.1% to 98.5% across the different faculties. Overall smoking prevalence was 5.07% (95% CI 3.2% to 7.1%), which is lower than previously reported national prevalence rates. Women reported smoking less than men did (OR=0.56, 95% CI=0.013 to 0.242; p=0.003). The majority of students supported tobacco control measures. The number of people who reported receiving formal training in tobacco cessation counselling ranged from 10.9% (95% CI 5.3% to 19.1%) among nursing students to 51.1% (95% CI 40.4% to 61.7%) among medical students. CONCLUSIONS: Smoking prevalence among this cohort was relatively low. Students were supportive of tobacco control policies. Further research is needed to understand what is working in this context, in order to apply lessons learnt in similar settings. In the meantime, health professional students should be provided health education to discourage tobacco use. Information on tobacco control policies needs to be more widely disseminated.

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.

Smoking prevalence, determinants, knowledge, attitudes and habits among Buddhist monks in Lao PDR.

BACKGROUND: This cross-sectional study, the first of its kind, uses baseline data on smoking prevalence among Buddhist monks in Northern and Central provinces of Lao PDR. FINDINGS: Between March and September 2006, 390 monks were interviewed, using questionnaires, to assess smoking prevalence including determinants, knowledge and attitudes. Data entry was performed with Epi-Info (version 6.04) and data analysis with SPSS version 11. Descriptive analysis was employed for all independent and dependent variables. Chi-square or Fisher's exact test were used for categorical variables to compare smoking status, knowledge, attitudes and province. Logistic regression was applied to identify determinants of smoking. Daily current smoking was 11.8%. Controlling for confounding variables, age at start of monkhood and the length of religious education were significant determinants of smoking. The majority of the monks 67.9% were in favor of the idea that offerings of cigarettes should be prohibited and that they should refuse the cigarettes offered to them (30.3%) but, in fact, 34.8% of the monks who were current smokers accepted cigarettes from the public. CONCLUSION: Some monks were smokers, whilst they, in fact, should be used as non-smoking role models. There was no anti-smoking policy in temples. This needs to be addressed when setting up smoke-free policies at temples.