Congenital heart disease at Laos Children's Hospital: Two year experience.

BACKGROUND: Management of congenital heart disease (CHD) in developing countries is challenging because of limited access to health-care facilities and socioeconomic limitations. The aim of this study was to describe the recent experience with CHD at Children's Hospital, Vientiane, Laos, the only pediatric referral hospital in the country. METHODS: From July 2013 to November 2015, 1009 echocardiograms were carried out in 797 individuals who visited Children's Hospital, in whom CHD was identified in 213. Demographic characteristics, echocardiography and age at first CHD diagnosis on echocardiogram were compared by residential area. RESULTS: Among the 213 patients, the most frequent anomalies, in descending order, were ventricular septal defect, atrial septal defect, patent ductus arteriosus, and tetralogy of Fallot. Moderate or severe CHD requiring surgery or intervention was detected in 137 patients; median age at initial diagnosis was 6.0 months (IQR, 1.5-29.8). Among those with moderate or severe CHD, 89 patients were from rural areas and 48 from the capital area. The proportion of patients from rural areas older than 1 and 3 years at diagnosis was 46.1% and 32.6%, respectively. In contrast, patients from the capital area were diagnosed at a significantly earlier age: 16.7% at age >1 year and 6.2% at age >3 years (both P < 0.001 vs rural areas). CONCLUSIONS: Diagnosis of CHD requiring surgery is delayed in Laos, especially in rural areas. Better education and training of local medical staff, and greater access to medical advice are required to improve CHD care in Laos.

The successes and challenges of the IMCI training course in Lao Pdr.

The purpose of this article is to explore whether the style and content of the IMCI algorithm and delivery of the training course match the needs and capacities of the Lao health workers. Unlike other IMCI studies that rely on external indicators, this study uses an open-ended qualitative approach to focus on the perspectives of the trainees through observation and trainee interviews. The findings showed that IMCI is a practical tool for health workers, and the interactive course is an effective way to teach it. Health workers responded that learning the algorithm was challenging due to the novel format and guidelines, but easy due to its clarity and straightforwardness. The main problems concerned the adaptability of guidelines and shortage of time. Incorporating in-depth clinical explanations and inviting facilitators with medical knowledge and experience using IMCI may be key to resolving such issues.

Prevalence of asthma, rhinitis, and eczema among children in Vientiane city, Lao PDR.

An International Study of Asthma and Allergy in Childhood (ISAAC) revealed a wide range of prevalences of childhood asthma in the world. Lao PDR had no such epidemiological data yet. This study aimed to investigate the epidemiology of asthma, rhinitis, and eczema in children in the country. A cross-sectional study was conducted in Vientiane City, the capital of Lao PDR, in 1997 using the ISAAC questionnaire. From three primary schools and one high school, 395 children, age 6-7 years, and 468 children, age 13-14 years, were chosen. The prevalence of asthma for children aged 13-14 years in Lao PDR was 25.6%, which ranks the highest in international asthma prevalence. The prevalence in allergic-rhinoconjunctivitis of children was 24.4% and atopic eczema was 7.1%. Contrary to generally accepted risk factors, there were no associations revealed between asthma prevalence and smoking of family members (especially mothers), intake of fish/meat, and male gender.

The first picture archiving and communication system in Lao People's Democratic Republic: Changes in the utilization rate of imaging tests in the first year after implementation.

BACKGROUND: Implementation of the Picture Archiving and Communication System (PACS) is more challenging in developing countries than in developed countries. Given that the first PACS in Lao People's Democratic Republic (PDR) was successfully installed at the Children's Hospital of Lao PDR, we aimed to investigate whether the utilization rate of imaging tests increased after PACS implementation. METHODS: PACS was implemented at the Children's Hospital of Lao PDR in December 2014. We compared the utilization rates of imaging tests including X-ray and ultrasound examinations between the pre-PACS period (from December 2013 to November 2014) and the post-PACS period (from December 2014 to November 2015). The utilization rate was defined as the number of imaging tests divided by the number of patients per month. RESULTS: The average number of total imaging tests was 225.8/month (standard deviation [SD], 37.7) during the 1-year pre-PACS period and was 269.4/month (SD, 38.5) during the 1-year post-PACS period (P=0.0103). The utilization rate of total imaging tests significantly increased after PACS implementation (pre-PACS, 2.47%/month; post-PACS, 4.23%/month; P<0.0001). Increased utilization rates were observed for both X-rays (pre-PACS, 1.65%/month; post-PACS, 2.38%/month; P=0.0004) and ultrasound examinations (pre-PACS, 0.82%/month; post-PACS, 1.85%/month; P=0.0001). CONCLUSIONS: The implementation of PACS at the Children's Hospital of Lao PDR resulted in a significant increase in the utilization rate of imaging tests, suggesting the indirect benefit of improved quality of care. Our findings showed that the benefits of PACS can be realized even in a resource-limited country such as Lao PDR.

Co-circulation of dengue virus type 3 genotypes in Vientiane capital, Lao PDR.

During the 2012 epidemic of dengue in Vientiane capital, Lao PDR, a major serotype switch from dengue 1 to 3 was observed. A molecular epidemiology study demonstrated that dengue 3 remained the predominant serotype in 2013, but also revealed the co-circulation of two genotypes, supporting the hypothesis of multiple geographic origins of dengue 3 strains circulating in Vientiane capital.