Public and private sector treatment of malaria in Lao PDR.

This study aimed to examine the care-seeking choices for treatment of a febrile illness compatible with malaria in the public and private sectors in Lao PDR. We conducted interviews with 745 heads of household in 14 villages in the Sekong province, using a structured-questionnaire. We asked each about who the care-providers were for febrile illness episodes affecting their household members during the past year. If patients used more than one care-provider for a single episode over a period of time, we identified patterns of the care-sequences for the initial and subsequent care choices. Then, we analyzed the relationship between the initial care choices and secondary care choices for care-providers by Chi-square test, categorizing care-providers into public (hospital, health centre, and village health volunteer) and private care-providers (private pharmacy, informal retailer, faith healing and herbs). As a result, we found that 624 patients sought care at least once, 255 (40.9%) twice, and 66 (10.6%) three times or more during a single episode. Of 138 patients who started with a public care-provider and then sought a secondary care, 71 (51.4%) switched to a private care-provider. In contrast, of 117 patients who started with a private care-provider and then sought a secondary care, 82 (70.1%) switched to a public care-provider (p<0.001). In conclusion, although most patients who failed being treated by a private care-provider switched to a public one, some exclusively relied on care within the private sector. An intervention is necessary to make the private sector an integral component of malaria treatment in Lao PDR.

Knowledge and behavior relating to malaria in malaria endemic villages of Khammouane Province, Lao PDR.

In order to provide basic data for evaluation of malaria control measures, a study on the knowledge and behavior of people regarding prevention of malaria was carried out in 8 malaria endemic villages in Khammouane Province of Lao PDR from 1999 to 2000. The total valid questionnaire respondents were 932, with a mean age of 32.3 +/- 14.9. 43.7% of the respondents were illiterate. About 44% of the respondents suffered from malaria in the past. About 55% of the illiterate group slept in mosquito nets, compared to 75.4% for the educated group. About 29% of the illiterate respondents had knowledge of malaria transmission by mosquito bites, compared to 48.8% for the educated groups. Out of 167 non-impregnated mosquito nets examined in two villages, 13 were in bad condition having holes or leaks and 39 female mosquitos including Anopheles spp were collected in these nets by early morning catches. Knowledge of malaria and behavior in relation to the prevention of malaria were significantly related to educational level. Health education as well as general education must be taken into account for communities in malaria endemic areas to become more involved in malaria control strategies.