Timeliness of immunisation with the pentavalent vaccine at different levels of the health care system in the Lao People's Democratic Republic: A cross-sectional study.

BACKGROUND: The timely administration of vaccines is considered to be important for both individual and herd immunity. In this study, we investigated the timeliness of the diphtheria-tetanus-whole cell pertussis-hepatitis B-Haemophilus influenzae type b (pentavalent) vaccine, scheduled at 6, 10 and 14 weeks of age in the Lao People's Democratic Republic. We also investigated factors associated with delayed immunization. METHODS: 1162 children aged 8-28 months who had received the full course of the pentavalent vaccine at different levels of the health care system were enrolled. Vaccination dates documented in hospital records and/or immunisation cards were recorded. Age at vaccination and time intervals between doses were calculated. Predictors for timely completion with the pentavalent vaccine at 24 weeks were assessed by bivariate and multivariable analyses. RESULTS: Several discrepancies in dates between vaccination documents were observed. In general, vaccination with the pentavalent vaccine was found to be delayed, especially in health care settings below the provincial hospital level. Compared to the central hospital level, less participants who were vaccinated at the district/health center level received the third dose by 16 (48% at the central hospital level vs. 7.1% at the district and 12.4% at the health center level) and 24 weeks of age (94.4% at the central hospital level vs 64.6% at the district-outreach and 57.4% at the health center level) respectively. In logistic regression analyses, lower education level of the mother as well as vaccination by outreach service, were independently associated with delayed completion of vaccination. CONCLUSION: We observed a general delay of vaccination, especially at lower ranked facilities, which correlated with indicators of poor access to health services. This highlights the need for further improving health equity in rural areas. Age-appropriate vaccination should become a quality indicator for the national immunization programme. In addition, we recommend further training of the health care staff regarding the importance of reliable documentation of dates.

Seroprotection at Different Levels of the Healthcare System After Routine Vaccination With Diphtheria-Tetanus-Pertussis whole cell-Hepatitis B-Haemophilus influenzae Type B in Lao People's Democratic Republic.

BACKGROUND: The Lao People's Democratic Republic continues to sustain a considerable burden of vaccine-preventable diseases because of incomplete vaccine coverage and weak vaccine responses. We have assessed seroconversion after routine vaccination with the pentavalent vaccine to capture weaknesses of vaccine management at the different levels of the healthcare system. METHODS: A total of 1151 children (aged 8-28 months) with 3 documented doses of the pentavalent vaccine delivered at central hospitals in Vientiane and the provincial hospital, 3 district hospitals, and 10 health centers in Bolikhamxay province were enrolled. Sociodemographic information was collected with a standardized questionnaire. Serum samples were analyzed for antibodies against vaccine components, and bivariate and multivariable analyses were performed to identify risk factors for low vaccine responses. RESULTS: Seroprotection rates at the provincial, district, and health center level were as high as in central hospitals, but seroprotection rates in areas covered by remote health centers were significantly lower. Protective levels also rapidly decreased with age at sampling. Seroprotection rates in Bolikhamxay against the different components reached 70%-77% and were up to 20% higher than in previous studies in the same region; 18.8% more children received the hepatitis B vaccine birth dose and the hepatitis B virus infection rate was 4 times lower. CONCLUSIONS: Vaccine immunogenicity has dramatically improved in a central province, likely due to training and investment in the cold chain. Nevertheless, there remains a need to focus on the "last mile" in remote areas were most children are vaccinated through outreach activities.

Strengthening the Engagement of Provinces in Health Workforce Planning and Management: A Case Study From Lao PDR.

The purpose of this health workforce plan is to provide guidance for the staffing of the Bolikhamxay. Province health services and the training of health service personnel to the year 2020. It must be stressed, however, that this plan is in its first iteration and does not provide all the solutions. Rather, it identifies issues that need to be further investigated and resolved at the local level. For example, the provincial health department (PHD) will need to further investigate the reasons for the significant variability in the utilization of services in different facilities and in the different ratios of staff in relation to the activities performed. The accuracy of the data must be validated and specific interventions must be determined. For Bolikhamxay, particular attention by PHD and district health authorities should be given to the following issues identified in the analysis:• Shortage of clinical staff, particularly in the age group 30 to 40 years old, to provide supervision, guidance, and support for junior staff in coming years;• The existence of health centers with less than minimum staffing level (<3), including a midwife and/or staff capable of properly addressing emergencies with particular reference to maternal and child health.• The median number of activities per staff per year is around 470 (Nakoun/Bolikhan), which means that, on average, a health worker will participate in fewer than two activities per day. The situation in some district hospitals and most health centers is even worse, with an annual average number of activities per staff of only 163, which means that, on average, one staff participates in one activity every 3 days, hardly enough to maintain skills and justify deployment.• This low level of staff activity raises questions about the need for further increase of staff supply to health centers and districts unless effective interventions are implemented to increase the demand and utilization of services in these facilities.• It is also necessary to document all relevant activities, including outreach activities and home visits, in order to give appropriate weight in the calculation of utilization and productivity.• Development of the provincial health workforce development plan requires validated human resources for health information and engagement of local health authorities, as well as strong collaboration with the national authorities and development partners, to ensure adequate support and resourcing.

Differences in preferences for rural job postings between nursing students and practicing nurses: evidence from a discrete choice experiment in Lao People's Democratic Republic.

BACKGROUND: A discrete choice experiment was conducted to investigate preferences for job characteristics among nursing students and practicing nurses to determine how these groups vary in their respective preferences and to understand whether differing policies may be appropriate for each group. METHODS: Participating students and workers were administered a discrete choice experiment that elicited preferences for attributes of potential job postings. Job attributes included salary, duration of service until promotion to permanent staff, duration of service until qualified for further study and scholarship, housing provision, transportation provision, and performance-based financial rewards. Mixed logit models were fit to the data to estimate stated preferences and willingness to pay for attributes. Finally, an interaction model was fit to formally investigate differences in preferences between nursing students and practicing nurses. RESULTS: Data were collected from 256 nursing students and 249 practicing nurses. For both groups, choice of job posting was strongly influenced by salary and direct promotion to permanent staff. As compared to nursing students, practicing nurses had significantly lower preference for housing allowance and housing provision as well as lower preference for provision of transportation for work and personal use. CONCLUSIONS: In the Lao People's Democratic Republic, nursing students and practicing nurses demonstrated important differences in their respective preferences for rural job posting attributes. This finding suggests that it may be important to differentiate between recruitment and retention policies when addressing human resources for health challenges in developing countries, such as Laos.

Antenatal care among ethnic populations in Louang Namtha Province, Lao PDR.

One in 33 women in Lao PDR dies due to pregnancy-related causes, which is the highest in Southeast Asia. This study assessed ANC utilization rates and the determinants for these rates; it also explored rural maternal decision-making regarding the place of delivery and immunizations for their children under age five years. A cross-sectional study was carried out in Viengphukha District, Louang Namtha Province, Lao PDR in January 2008. Of 1,005 household representatives, 620 who had children age under five years were interviewed using a semi-structured questionnaire. Nearly one-quarter of mothers (23.4%) had at least one ANC visit during their most recent pregnancy, of which 4.5% had > or = 4 ANC visits. ANC visit rates among lowland and midland mothers were 3.6 and 7.6 times higher than highland mothers, respectively (p < 0.005 and p < 0.001). Mothers with no ANC were more likely to deliver at home (adjusted OR = 18.0; p < 0.0001). Home deliveries were more common among highland than lowland mothers (adjusted OR = 10.5; p < 0.05). Children born to mothers who had no ANC visit were more likely to not complete routine immunization than those who were born to mothers who had ANC visits (adjusted OR = 1.9; p < 0.01). Low ANC utilization rates in Lao PDR were observed among ethnic minority mothers who were less educated. ANC visits enhanced hospital deliveries and child immunizations. The promotion of ANC among women in remote rural communities is needed.

Seasonal pattern and genotype distribution of norovirus infection in Japan.

A total of 6231 fecal specimens collected from infants and children with gastroenteritis in 7 different regions of Japan during 1995 to 2007 were examined for norovirus. Norovirus was detected in 779 patients (12.5%) and norovirus activity peak in the winter season (November to January) during 1995 to 2007. During the last 11 years, NoVGII/4 was the predominant strain in Japan followed by GII/3, GII/6, GII/2, GII/12, and GI.

Seasonal trend and serotype distribution of rotavirus infection in Japan, 1981-2008.

A total of 10,917 fecal specimens from infants and children with gastroenteritis in seven different regions of Japan in the last 3 decades were examined for rotavirus. We observed that the rotavirus peak shifted gradually from January to April (winter to early spring) during 17 seasons and the G1P[8] combination was the most predominant genotype in the last 28 years in Japan.

UXO victims and health status of populations living in Xiengkhuang Province, Lao PDR: A household-based survey.

During the Vietnam War from 1964 to 1973, over 2 million tons of bombs were dropped on Laos. Approximately 30% of the bombs did not explode and have posed a continued threat to civilians throughout the country. Approximately 200 casualties per year have been reported nationwide. Therefore, we conducted a household survey to better understand magnitude of UXO victims, accessibility to the MCH services and child healthcare seeking behaviors of the population in the Xiengkhuang province. The household-based survey was carried out in February 2006 among 6 of 541 villages. 283 household representatives were interviewed. The cumulative number of UXO victims identified from 1973 to 2005 was 45 casualties, of which 9 (20.0%) occurred in the year 2005. 37.5% reported knowledge of danger zones for UXO contamination. Among the 91 children under the age of 5 years, households on average reported 1.7 episodes per year for diarrhea, 2.7 for respiratory disease, 2.3 for fever and 1.7 for measles. 69.4% of children under five were completed the routine immunization program, 62.6% of mothers used ANC service for their most recent pregnancy, 58.2% accessed family planning services, and 28.6% delivered their most recent child at a healthcare facility. UXO victims in the targeted villages sharply increased in 2005. Insufficient knowledge about UXO danger and MRE seems to be a central factor in the high rate of UXO-associated accidents. Diarrhea, respiratory disease and measles remained health problems for children under 5 years. MCH services utilization were higher than Laos nationally.

Prevalence and potential risk factors of rhinitis and atopic eczema among schoolchildren in Vientiane capital, Lao PDR: ISAAC questionnaire.

In 1998, an epidemiological study on asthma and allergic diseases using ISAAC questionnaire in Laos was first conducted in the recommended schools located in Vientiane capital showing that the prevalence of rhinoconjunctivitis and atopic eczema were 23.7% and 7.1% among children aged 13-14 year-old, respectively. This study aimed to reassess the prevalence of rhinoconjunctivitis and atopic eczema using the same ISAAC questionnaire by employing random sampling method and to identify the potential risk factors for these rhinitis and atopic eczema. This school-based cross-sectional study was conducted in Vientiane capital from December 2006 to February 2007. Of 536 children, prevalence of rhinoconjunctivitis and atopic eczema among schoolchildren were 9.3% and 11.8%, respectively. Children with early respiratory infection (AOR = 4.06; p = 0.001), parasitic infestation especially by Opisthorchis viverrini (AOR = 3.41; p < 0.05) were more likely to have rhinitis. While history of measles (OR = 2.24; p < 0.01) and respiratory infection (OR = 1.96; p < 0.05), eating vegetables everyday (AOR = 2.96; p < 0.01) were associated with atopic eczema. The similarity of prevalence of rhinitis and rhinoconjunctivitis were also revealed between children aged 13-14 year-old in this study and 6-7 in the previous study in 1998. The validation study on ISAAC questionnaire in Lao language is needed in order to generalize this questionnaire in Lao.

Parasitic infestation and nutritional status among schoolchildren in Vientiane, Lao PDR.

AIMS: To investigate the prevalence of intestinal parasitic infestation among school-aged children residing in Vientiane capital city; and to assess the impact of its infestation on nutrition status of those children. METHODS: The school-based cross-sectional study was conducted from December 2005 to February 2006. The systemic random samplings were employed to select schools and schoolchildren. Five hundred and thirty-six schoolchildren (350 high-school children and 186 parents of elementary-school children) were completely interviewed by semistructured questionnaire and performed anthropometric measurement. The direct faecal smear was employed to analyse 299 (55.8%) stool samples. The SPSS version 12.01 and Epi Info version 6.0 were used for data analysis. RESULTS: The overall prevalence of parasitic infestation was 38.1%, with 18.1% of Opisthorchis viverrini and 14.7% of Ascaris lumbricoides. The prevalences of stunting and underweight were 20.2% and 20.0%, respectively. The prevalences of stunting (OR = 3.28; P < 0.01) and underweight (OR = 2.69; P < 0.05) were higher among high-school children who were infested by intestinal parasites. CONCLUSION: Approximately one-third of schoolchildren in Vientiane capital city were infested by intestinal parasites. The persistent parasitic infestation seemed to be associated with growth rate pattern among those children. School-based parasite control programme and health promotion are needed to eliminate this major public health problem in Lao People Democratic Republic.

Factors affecting routine immunization coverage among children aged 12-59 months in Lao PDR after regional polio eradication in western Pacific region.

The global poliomyelitis eradication programme had a great impact on routine immunization coverage in Lao PDR: DPT3 increased 23% in 1992 to 56% in 1999; OPV3 27% to 64%. However, after the achievement of regional eradication, coverage became stagnant in accordance with the withdrawal of various sources of financial supports. In place of the former funds, a public-private global partnership began to support EPI. We aim to explore factors affecting routine immunization coverage. From February to March of 2005, a cross-sectional questionnaire survey was conducted, targeting 341 mothers living in two districts where immunization coverage was the lowest and the middle in Oudomxay province. DPT3 coverage was 72%, higher than the national target of 65%; however, the drop-out rate was 21%. Influential factors on fully immunized child was distance, literacy, possession of livestock; mothers knowledge of immunization target diseases, measles immunization schedule; and mother's willingness to pay for immunization. In total, 98% of all mothers lived within a 30-minute walk of the immunization site. Household visits increased the immunization status among mothers who were illiterate, utilizing an outreach site for immunization, not willing to pay for immunization, receiving home delivery, and without health education attendance. The much higher routine immunization coverage especially in a district of poor EPI activities suggests a well-designed primary health care approach under the district strategy, the zone-zero social mobilization strategy and good lines of communications; it also points to the benefits of the polio eradication initiative. Household visits were found to be effective for people living with difficulties in such as education, living location, and finance. An equally shared funding system for the basic health as well as international policy for respecting the existing system in poor country is important.