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.

High HIV vulnerability of ethnic minorities after a trans-Asian highway construction in remote northern Laos.

From 2004 to 2008 a new Asian highway was constructed through remote multiethnic areas of north Laos linking a low with higher HIV prevalence areas in bordering Thailand and China. We assessed the HIV vulnerability in four minority villages alongside the new road in Luang Namtha Province using structured interviews and voluntary counselling and testing (VCT) for HIV. Of 470 villagers aged 15-49 years old, 47.0% did not know any ways of HIV transmission yet 82.1% reported sexual contacts. Median age at first sex was 17.5 years. Sex of never-married 15-24 years old was associated with higher age (P = 0.002) and ethnicity (P = 0.013; Hmong odds ratio [OR] 7.27); 61.9% (86/139) used no condom at last non-cohabitant sex, especially women (OR 17.7, P < 0.001) and older villagers (P = 0.001). No HIV-infection was detected among villagers who received VCT in 2006 (924 of 933) and 2008 (538 of 1249). Nonetheless our findings reveal an alarming vulnerability for HIV among ethnic minorities alongside the new highway, and further culturally adapted prevention efforts are warranted.

A study of anemia in pregnant women with Plasmodium falciparum at district hospitals in Vientiane, Lao PDR.

A descriptive cross-sectional study was carried out among pregnant women attending antenatal care at the district hospital, with suspected clinical manifestation of malaria in order to determine the prevalence of anemia and malaria among pregnant women and to determine any correlation between degree of anemia and degree of malaria parasitemia in pregnancy with malaria infection. This is a quantitative research method using face-to-face questionnaire. This study was undertaken at the district hospitals of Vientiane Prefecture and Vientiane Province. Sixty-eight pregnant women with suspected malarial clinical manifestations attending the antenatal care at these hospitals were recruited during June - October, 1998. The subjects were asked about their sociodemographic, socio-economic characteristics, gravida and parity, gestational age, last pregnancy and past history of hematology diseases. Blood samples (dry smear for thick and thin blood films) were examined at the same time for Plasmodium falciparum. The study showed that the prevalence of anemia (Hb < 11 g/dl) and severe anemia (Hb 4-6.9 g/dl) in the total sample population was 48.5% and 8.8% respectively. However, the prevalence of anemia among pregnant women with malaria was 68.75% compared to those without malaria infection (42.31%), but the difference was not statistically significant (p=0.117). A plausible explanation could be small sample size. The prevalence of severe anemia in pregnancy with malaria parasitemia was 18.8% compared to those without parasitemia (5.8%). The difference was not statistically significant (p=0.102). The difference of the mean hemoglobin level in falciparum positive cases and falciparum negative cases was clinically and statistically significant (RR = 1.63 and p=0.00679). There was some evidence of a negative correlation between the degree of anemia and parasitemia count (r= -0.19 and r2= -0.04). In conclusion this population had high prevalence of anemia in pregnant women and P. falciparum may be the main factor associated with anemia. There is a need to investigate other causes of anemia among pregnant women. Our results suggest that frequent and regular antenatal monitoring is necessary for the pregnant women. They should be encouraged to attend antenatal clinics through health education, increased health personnel awareness of proper management for the pregnant women with fevers from malarial endemic areas. There is a need for further research in this area in order to obtain adequate sample size.