Changes in household food security, access to health services and income in northern Lao PDR during the COVID-19 pandemic: a cross-sectional survey.

OBJECTIVES: We assessed the relative difficulty in meeting food needs during the COVID-19 pandemic compared with before; determined the relationship between pandemic-associated difficulties in food access and household, maternal and child food security; and identified resiliency-promoting strategies. DESIGN: A cross-sectional survey of households undertaken in November 2020. SETTING: Rural districts of Luang Prabang Province, Lao People's Democratic Republic. PARTICIPANTS: Households (N=1122) with children under 5 years. PRIMARY AND SECONDARY OUTCOMES MEASURED: Survey respondents reported the relative ease of access of food and healthcare as well as changes in income and expenditures compared with before March 2020. We determined indicators of food security and source of foods consumed for households, women and children, as well as prevalence of malnutrition in children under 5. RESULTS: Nearly four-fifths (78.5%) found it harder to meet household food needs during the pandemic. The most common reasons were increased food prices (51.2%), loss of income (45.3%) and decreased food availability (36.6%). Adjusting for demographics, households with increased difficulty meeting food needs had lower food consumption scores and child dietary diversity. Over 85% of households lost income during the pandemic. Decreased expenditures was associated with reliance on more extreme coping strategies to meet food needs. The households who experienced no change in meeting food needs produced a greater percentage of their food from homegrown methods (4.22% more, 95% CI 1.28 to 7.15), than households who found it more difficult. CONCLUSIONS: Pandemic-associated shocks may have large effects on food insecurity. Action is needed to mitigate consequences of the pandemic on nutrition. Local food production and safety net programmes that offset income losses may help.

Developing a Mentorship Program in Laos.

Skills strengthening and capacity building for maternal and newborn health (MNH) providers are essential to ensure quality care for mothers and newborns. There is, however, limited research regarding what constitutes an effective model in low-income countries. The Lao People's Democratic Republic (Laos) has some of the region's worst outcomes for neonatal and maternal mortality. Moreover, with a 23-year hiatus in midwifery training, which ended approximately 7 years ago, there is a cadre of new and inexperienced midwives in practice without support systems, skills, or continuing professional development opportunities. Traditional didactic teaching methodologies prevail in Laos, but with little evidence of efficacy. As an alternative model, Save the Children International has been implementing a mentorship approach for MNH providers in two provinces in northern Laos since January 2016, with technical guidance and funding from the United States Agency for International Development-supported global Maternal Child Survival Program. This community case study will describe and reflect on the approach by highlighting the need and rationale for mentorship, followed by a description of the program's core components and the results observed so far. Lessons learned and the application of the approach to different contexts and health-care professionals, considering both constraints and opportunities, will be discussed.