Patterns of trematode infections of Opisthorchis viverrini (Opisthorchiidae) and Haplorchis taichui (Heterophyidae) in human populations from two villages in Savannakhet Province, Lao PDR.

The liver fluke, Opisthorchis viverrini, and the minute intestinal fluke, Haplorchis taichui, are prevalent in many Asian countries. This study analysed the patterns of infections of O. viverrini and H. taichui in Lahanam and Thakhamlien villages (Savannakhet Province, Lao PDR), in two cross-sectional investigations. Out of a total of 207 human participants, post-anthelmintic treatment positivity rates for expelled worms were 170 (82.1%) for H. taichui and 65 (31.4%) for O. viverrini. Both these species co-exist in the study villages. When each parasite was analysed separately, H. taichui infections reached a plateau among people aged >20 years. Opisthorchis viverrini infection rates were highest in the age group 21-30 years, with decreasing infection rates after the age of 30. Our findings indicated that fish-borne trematode infections were more prevalent among adults. Fish, common intermediate hosts, were acquired in the study area for analysis. The examination of 35 species of fish as intermediate hosts found O. viverrini metacercariae in only six species, and these were found mostly during the month of November. Many farmers who live on the rice fields obtain their food from their immediate environment, including these intermediate-host fish, potentially putting them at greater risk of O. viverrini infection. By contrast, H. taichui metacercariae were found in three species of fish obtained from the market, meaning that anyone could consume them and become infected. If people who work in rice fields limit the species of fish they consume, or avoid consuming raw fish during the month of November, they may reduce their risk of O. viverrini infection.

Equity, privatization and cost recovery in urban health care: the case of Lao PDR.

Along with the shift from a planned to market-oriented economy, as in many other developing countries, Lao PDR has promoted health care partnerships with the private sector, and cost recovery in public hospitals, to increase resources in the public sector, while at the same time attempting to ensure appropriate access to health care for those without means to pay. In a multi-case design, this study compares two neighbourhoods of different socioeconomic status comprising 10 households, representing urban districts in three provinces. In-depth interviews were conducted over a 1-year period with three visits to each household. Members of the households were interviewed on their perceptions and utilization of health care services. Focus group discussions of public providers and individual interviews of private providers, leaders of the villages and hospital administrators provided complementary perspectives. The study found that both socioeconomic groups utilized private health services as their first choice, including private clinics and treatment abroad for those with high socioeconomic status, while the low socioeconomic group preferred private pharmacies. The unwelcoming attitudes of health staff and procedural barriers have led both groups to meet their health care needs in the private sector. Here the health care they receive is strictly limited to what they can pay for. For the poor, in most cases, this means drugs alone, i.e. no examination, no diagnosis and only limited advice. Limited financial resources often means receiving inappropriate and insufficient medication. Equity in health care remains theoretical rather than practical and the social goals of the reform have not been achieved.

Building the national drug policy on evidence--a cross sectional study on assessing implementation in Lao PDR.

The National Drug Policy (NDP) of Lao PDR, endorsed in 1993, has since 1995 been implemented through an intervention program in five pilot areas out of 18 provinces, including training of health personnel. The aim was to assess the impact of the NDP program to get evidence for revising the policy. In a cross sectional design, comparisons were made between the pilot province of Luangphrabang (LPB) and the non-pilot province of Sayabury (SBR). In each province, three districts were purposively chosen. Four pharmacies at the public hospitals were included, while 20 private pharmacies were randomly selected. A set of 29 combined indicators was utilized. One hundred and ten prescriptions for under-five children with simple diarrhea and 240 adult outpatient prescriptions were sampled. Furthermore, twelve health care managers were interviewed on knowledge and attitudes. LPB health managers had better knowledge of NDP concepts. Significantly more essential drugs (ED) were available in the private pharmacies in the pilot province. The proportion of prescriptions of ED in hospitals was higher in the pilot province (95% in LPB vs 86% in SBR; p<0.001). Fewer drugs per patient were prescribed in the pilot province (2.7 vs 3.3, p<0.001), and the management of simple diarrhea in children was significantly more in accordance with Standard Treatment Guidelines. The pilot province performed significantly better regarding several aspects of quality and rational use of drugs, probably related to the implementation program. National as well as regional and global diffusion of research findings is recommended towards evidence-based national drug policies.