Severe P. falciparum malaria kills people, particularly African children ~ 200,000 per year. Quinine and quinidine infusions were the only antimalarial drugs available to treat severe malaria until recently. The rediscovery of artemisinins in 1972 and subsequent synthesis of artemether and artesunate have provided highly effective alternatives to quinine. Results from meta¬analysis demonstrated that artemether significantly reduced mortality in adult patients with severe malaria from Southeast Asia. Pharmacokinetic studies suggest that the oil¬soluble artemether, which can be given intramuscularly but not intravenously, is poorly and slowly absorbed from the injection site while the water¬soluble artesunate is absorbed rapidly and reliably. The SEAQUAMAT study comparing intravenous artesunate vs quinine among adults and children in 4 Asian countries and demonstrated a significant absolute reduction of mortality of 34.7% (95%CI = 18.5 – 47.6%). A subsequent study (AQUAMAT study) conducted in African children with severe malaria in 9 countries confirmed the excellent efficacy of artesunate with a significant relative reduction of death of 22.5% (95%CI = 8.1 – 36.9%). A large meta¬analysis with more than 7,000 patients also confirmed that artesunate significantly reduced mortality in Africa of 22.5% and that in Asia of 38.6%. Patients treated with quinine had significantly higher incidence of hypoglycemia when compared to those who received artesunate. If these studies had been conducted 20 years earlier, perhaps 4 million patients with severe malaria would not have died particularly African children. Parenteral artesunate should replace quinine everywhere in the world as the first line treatment of severe falciparum malaria. Such a change in policy would save an estimated 200,000 live of children with severe malaria each year. With support from the Global Fund for the fight against AIDS, Tuberculosis and Malaria (GFATM), Laos changed the national policy of severe malaria treatment to artesunate as first line in 2006.

Beriberi (vitamin B1 or thiamin deficiency) is neglected health problem that probably remains as a significant cause of mortality among infants in Asia. There has been very little research in the last 4 decades. Although there are few data from Laos, the clinical experience of Lao pediatricians, along with some data from Mahosot Hospital in Vientiane, suggests that beriberi is probably an important cause of infant mortality, which is currently very high in Laos. Diagnosis of infantile beriberi can be clinically if signs are evident. However, a significant number of infants may have clinical unapparent vitamin B1 deficiency, complicating their illness, which is impossible to diagnose unless biochemical assays are performed. Unapparent vitamin B1 deficiency may complicate the illness of infants presenting with other diseases and supplementary treatment with vitamin B1 could potentially improve their outcome and reduce infant mortality. Two recently published papers by the Wellcome Trust – Mahosot Hospital – Oxford Tropical Medicine Research Collaboration suggested that approximately 13% of Lao sick infants admitted with diarrhea, pneumonia and sepsis (without clinical evidence of beriberi) at the Pediatric Wards, Mahosot Hospital, Vientiane had evidence of biochemical vitamin B1 deficiency particularly among those aged > 2 months. Infants with biochemical vitamin B1 deficiency had higher mortality than those who were not B1 deficient. The study also demonstrated that the activation coefficient (α), which has been used to diagnose vitamin B1 among adults living in non¬rice eating societies, cannot be reliably used for the diagnosis of vitamin B1 deficiency in infants, that basal ETK < 0.59 micromoles/min/gHb is a better biochemical marker of infantile beriberi, and that detection of the cardiac dysfunction marker troponin T may be useful indicator of infantile beriberi. The implication of the findings in these two papers were that (i) since clinical unapparent vitamin B1 deficiency is common among Lao sick infants, co¬treatment with vitamin B1 may reduce disease severity and mortality, (ii) since basal ETK is more accurate than activation coefficient (α) in the diagnosis of infantile beriberi, basal ETK should be used for the diagnosis of vitamin B1 deficiency among infants, and (iii) since troponin T may be useful in the diagnosis of infantile beriberi and as this assay is now available as a bedside test these should be evaluated as accessible markers.

Rational and Background: Diarrhea remains an important cause of morbidity and mortality among children under five (U5) in Laos. Complications of paediatric diarrhea are not uncommonly found among the children admitted to hospitals. Incorrect home¬care practice of children with diarrhea by their guardians may be an important factor contributing to such complications. Methodology: A cross¬sectional, descriptive study was carried out at three central hospitals of Vientiane Capital (Mahosot, Mother and Child, and Setthathirat) between January and February 2010 with objectives to (1) determine the frequency of diarrhea complications among U5 children, (2) describe home care behavior of diarrhea by care¬givers, and (3) correlate such behavior with complications. Results: During the study period 3,722 U5¬children presented or were admitted to the three hospitals. Of these 880 (24%) had diarrhea. Of all children with diarrhea, 262 children and their guardians were studied. All children had been treated before presenting to the study hospitals [home¬care by guardians (52%), treated in public hospitals (34%) and in private clinic (14%)]. One hundred and seventy¬one children (65%) had at least one complication at presentation including dehydration (48.5%), malnutrition (27%) and abdominal distension (12%) with one intussusception (0.4%). Treatments given to the children before presenting to the hospitals were ORS (83%), antibiotics (46%), anti¬diarrheals (25%), herbal medicines (8.5%), and antiemetics (5%). Ninety percent of the guardians had correct knowledge of diarrhea definition and on how to prepare ORS but only 32% and 27% of the guardians increased quantity of daily fluid and food, respectively, to their children during diarrhea. The mean (95%CI) years of schooling of the guardians whose children had complications at presentation were significantly lower than those whose children did not have complications [8.5 (8.1 – 8.9) vs 9.2 (8.2 – 9.6), P = 0.04]. Children who received anti¬diarrheals and antibiotics before presentation were 5 and 3 times, respectively, likely to have complications when compared to those who did not [OR = 4.9, 95%CI = 2.2¬10.9; P < 0.001 and OR = 3.4, 95%CI = 1.9 – 5.9; P < 0.001; respectively]. Children treated with anti-diarrheals and antibiotics prior to presentation were 26 and 5 times, respectively likely to have abdominal distension compared to those without treatment [OR = 26.1, 95%CI = 9.4-72.4; P < 0.001 and OR = 4.8, 95%CI = 2.0¬11.7; P < 0.001; respectively]. Children who were given normal quantity of fluid by the guardians during diarrhea were 1.5 times likely to be dehydrated when compared to those who received increased quantity of fluids [OR = 1.6, 95%CI = 1.1¬2.2; P = 0.002]. Conclusion: Half of Lao U5¬children with diarrhea admitted or presented at central hospitals in Vientiane Capital had been treated by their caregivers and 2/3 of them had at least one complication. These complications were significantly associated with incorrect home¬care practice by the guardians especially treatments with anti¬diarrheals and antibiotics.

Rational and Background: University of Health Sciences (UHS) is a unique health institution in Laos that trains medical doctors. Annually more than 150 new medical doctors graduate from this institution but only some of them are recruited in the government health sector and a small number of them continue their higher medical education. Post¬graduate education has increasingly been established and developed at the UHS but very little is known about the expectation and awareness on post¬graduate medical training of the final year medical students. Understanding this issue may help health policy makers to develop strategic plans for medical doctor training appropriately and realistically. Additionally, attitude and suggestion of medical students on the current training program would also be important and essential to improve the curriculum. Methodology: This was a descriptive study to explore the expectation and awareness of the final year medical students on post-graduate medical training at the UHS including their attitude and suggestion towards the current medical training using face¬ to ¬face interview technique with application of pre-designed and pre¬tested questionnaire. Results: Of the 208 final year medical students in the academic year 2010, 186 (89.4%) were interviewed. The proportion of the students with expectation to continue their post¬graduate medical training was 53% (98/186) while the remainder wished to work following their graduation. The percentage of students who wished to continue their training was not significantly different between those who came from provinces [60/120 (50%)] and those who lived in Vientiane Capital [38/66 (58%)], P = 0.32 but this figure was statistically lower among those who had previously worked as health workers compared to those who had not [4/20 (20%) vs 94/166 (57%), P = 0.006]. Only 64.5% of all respondents knew that there is post¬graduate medical training at the UHS. Residency (90%) and family medicine (85%) training programs were the most common post¬graduate medical education of which they were aware but only 21% them correctly understand about residency training program and 16.6% about family medicine program. The training programmes that respondents most commonly stated that they would like to study were OBGY (21%) and Internal Medicine (21%). Among 81 interviewees (43.5%) who expected to work following their graduation, 68 (84%) intended to work for the government sector particularly in the public hospital (75%) for the reason that they wanted to help patients (53%). Only 7.5% of all respondents mentioned that the existing undergraduate training program was good and did not require further improvement while the remainder strongly suggested that the curriculum need to be revised with the emphasis on more practice in the laboratory and hospital. Conclusion: Approximately half of the last-year medical students (academic year 2010) expected to work in clinical practice while the rest wished to continue their further training. But their understanding of the post¬graduate training programs was very low. Most of these students suggested that the existing undergraduate training program be revised with the emphasis on more practice in the laboratory and hospital.

Rationale and Background: Risk factors associated with Type 2 diabetes mellitus (DM) may differ between population groups and ethnicities. In Lao PDR (Laos), no studies have been conducted to investigate the potential risk factors for Type 2 DM. Methodology: A case-control study was conducted among 150 patients with Type 2 DM who were matched for age and sex with 300 patients presenting at OPD with non-DM diseases, at Setthathirath Hospital between November 30, 2007 and April 30, 2008. Results: Most of the study patients (97.5%) were Lao Loom with an overall mean (95%CI) age of 57.6 (56.6- 58.5) years. The mean (95%CI) daily expense (Lao Kip) was significantly higher in cases [38,700 (35,213- 42,186)] compared to controls [31,400 (29,667-33,132)] (P<0.001). The median (range) number of bottles or cans or glasses of sweet soft drink drunk by the study subjects per week (Pepsi or fruit juice or sugar cane juice) were significantly higher in the cases compared to the controls (P<0.001). Although the proportion of the patients who previously drank alcohol was similar between two groups, the mean (95%CI) number of glasses of whisky drunk by the patients per week was significantly higher in the cases [4.1 (2.8-5.4)] compared to the controls [1.8 (1.4-2.3)] (P<0.001). The percentage of patients with history of cigarette smoking and the mean (95%CI) number of cigarettes smoked per day were not significantly different between the groups (P>0.05). Although the frequency of the patients who did regular physical exercise was not statistically different between the cases (31%) and the controls (27%) (P=0.48), the mean (95%CI) body mass index was significantly higher in the cases [28.3 (27.7-28.9)] compared with the controls [24.9 (24.5-25.4)] (P<0.001). A history of family members with DM was significantly higher among the type 2 DM cases (31%) compared with the controls (16%) (P<0.001), [OR= 2.3; 95%CI = 1.4 - 3.7)]. The history of NSAID/Steroid and traditional-herbal use was associated with type 2 DM [OR = 2.6; 95%CI = 1.3 - 5.0) and OR = 2.7; 95%CI = 1.7 - 4.6), respectively]. Conclusion: Higher expenditure, sweet soft drink consumption, BMI, a history of family members with DM, and history of NSAID/steroid or traditional herb use were risk factors associated with type II DM among Lao patients. Further studies are required in order to confirm the findings of this study especially in different hospitals and parts of Laos. Copyright: ! 2012 Xaysanavong et al. This is an open-access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Rational and Background: The University of Health Sciences (UHS) is the only health institution training medical doctors in the Lao PDR. The curriculum of the Faculty of Medicine has been developed and improved but no formal evaluation has been performed. Feedbacks on the current learning-teaching situation by medical students are essential and important as they are directly exposed to the real learning-teaching situation. Methodology: This was a descriptive study of feedback from the sixth year medical students (academic year 2010-2011) on the current learning-teaching situation of the Faculty of Medicine, UHS, using a pre-designed, pre-tested and self-administered questionnaire between January – February 2011. Results: Of a total of 162 students, 161 participated in the survey. Only 50% of the respondents reported that they ‘really like’ to study medicine at enrollment. This figure was consistent with the proportion of the students who said that they had successfully passed the entrance examination (56%). However, 86% of the interviewees stated that they ‘like medicine’ after six years of study. Only 44% of the students reported that they had regularly paid attention to the lectures. Approximately half of them mentioned that the basic sciences they had learnt at the beginning of their medical training were useful for medicine and 94% suggested adding anatomy and physiology to the first year class. The majority (78%) of students complained that they had had too little practical experience in the laboratories and hospitals. Forty-two and 54 % suggested that the students should have worked in the hospitals from the second and third years of their training, respectively. More than half (60%) said that the number of lecturers was insufficient, 36% stated that the lecturers are sufficiently knowledgeable, 20% stated that the lecturers were knowledgeable and adequately passed on their knowledge to the students, and 63% of them reported that the lectures were not always updated. Most of the respondents (84%) said that the number of the students in the class was too big and crowded and this negatively affected the learning-teaching atmosphere. Two third of the interviewers said that educational materials and equipment were not adequate, 86% mentioned that textbooks in the University library were not sufficient and lacking while the internet room did not respond to the need of the students (94% said that the internet room opened late in the morning but closed too early, there are not enough computers, and internet speed was too slow). Eighty-three percent of the students complained that the laboratories and hospitals were too small and did not respond to the need of the students. Conclusion: This study clearly demonstrated that the current learning-teaching of the Faculty of Medicine, University of Health Sciences needs to be evaluated, revised, and improved urgently in order to ensure that the newly graduated doctors are fully knowledgeable and qualified. Copyright: ! 2012 Hang et al. This is an open-access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Rational and Background: Advertisements are forms of communication used to encourage or persuade an audience to continue or to take some new action, usually to purchase. Product and service adverts on Lao television have significantly increased recently. However, very little is known about the frequency of health- related adverts on Lao television and whether they are containing Lao appropriate public health messages. Study of the frequency and potential impact of health-related adverts might help us to better understand the situation and contribute to solving health-related problems of Lao people. Methodology: This was a descriptive study to describe the adverts on Lao television during three months (February – April 2011). All Lao television adverts broadcasted during three months were tape-recorded and information was extracted on a pre-designed form. All adverts were analyzed and classified as health-related and non health-related. The time of adverts was also calculated. Data were entered into excel sheet and analyzed using STATA 10.0. Results: During three months, 34 adverts were observed on all three Lao television channels. Of these, 28 (82%) were health-related and 6 (18%) were not. Of 28 health-related adverts, 10 (36%) were classified as good for Lao public health, 3 (11%) were considered as dangerous to health, and 15 (53%) were of uncertain classification. All three adverts regarded as ‘bad’ to health were advertising beverages containing alcohol or caffeine. The average advert durations were 1.5 minutes and 1 minute for those advertising alcohol- and caffeine- containing beverage. Over three months, 3,702 spots of these three adverts were on air with an average total exposure time of 82.5 hours, which was longer than those considered as ‘good’ for health (2,068 spots over 32.9 hours). Some products were exaggeratedly advertized which might mislead the audience and negatively affect their health. Conclusion: More than 80% of all Lao TV adverts were health-related, but 2/3 were classified as potentially harmful to health. The frequency and total duration of health-related adverts, which were considered to be harmful to health, were higher and longer, respectively, when compared to those considered to be good for health. This study suggests that Lao people are exposed to adverts that are contrary to the interests of Lao public health. Strict measures to ensure that advertisements are accurate and do not mislead people, persuading them to buy things that are not in the interests of Lao public health, are required.

Background: Global guidelines from the World Health Organization on discharging patients diagnosed with COVID-19 changed in 2021 to a symptom-based rather than negative PCR-based approach. Studies have shown that shedding of viable virus continues for approximately eight days after symptom onset in most patients. In Vientiane, Laos, until now, patients diagnosed with asymptomatic or mild COVID-19 are hospitalised for 2 weeks and then, if they still test PCR positive for SARS-CoV-2, stay for a further week in a designated quarantine hotel before being discharged home. Objective: The aim of this pilot study was to investigate the risk of transmission of SARS-CoV-2 to household contacts of discharged patients who are still PCR-positive following 2-3 weeks quarantine in Vientiane, Lao PDR. Methods: Adult participants, who were resident in Vientiane Capital and who were about to be discharged from hospital (after 2 weeks hospitalisation), or from a quarantine hotel, following a further one-week quarantine, were screened to assess eligibility for the study. The household of each case was visited a maximum of 48 hours before or up to 24 hours after the participant was discharged and a nasopharyngeal swab was taken from all household members. Repeat nasopharyngeal swabs from cases and contacts were taken on day 7 and day 14 after discharge home of each case. Results: Between 20th May 2021 and 27th August 2021, 55 cases and 84 contacts in 27 households were enrolled in the study. The median [range] age of all 139 included participants was 26.5 years [3 months to 83 years] and 83 (60%) were female. By household, the median [range] number of cases and contacts were 1 [1-6] and 3 [1-13] respectively. At discharge home 32/48 (67%) cases tested positive for SARS-CoV-2. By day 7-11 of 47 cases (23%) still tested positive for SARS-CoV-2 by PCR and by day 14 this number was 2/24 (8%). No contacts tested positive during follow up and the numbers tested at the time of discharge of the case, 7 days later and 2 weeks later were 56, 57 and 37 respectively. Loss to follow up at day 7 and day 14 ranged from 15-50% (participants not at home at the time of visits). Conclusion In this pilot study we found no evidence of onward transmission of SARS-CoV-2 to contacts of cases discharged home with a positive PCR result. This suggests the current discharge policy for mild to moderate COVID-19 case following 2 weeks in hospital in the Lao PDR is safe.

Introduction: Neonatal sepsis is a major cause of morbidity and mortality among newborns. Sepsis accounts for 30-50% of all neonatal deaths in developing countries. C-reactive protein (CRP) has been used to predict neonatal sepsis with high sensitivity and specificity. Currently, blood culture is the gold standard for neonatal sepsis diagnosis, but it takes at least 48 hours to 7 days and not all cases have positive culture in neonatal infection. Objective: To assess the performance of C-reactive protein for predicting neonatal sepsis. Methodology: A prospective and retrospective descriptive study in neonates aged up to 28 days old presenting with symptoms and signs of sepsis and maternal high-risk factor of neonatal sepsis at Pediatric Intensive Care Unit of Mahosot Hospital. C-reactive protein rapid test was considered positive if the test level was ≥6mg/L. Blood culture was used as reference test. Result: Among 725 neonates recruited in the study, 3.9% blood cultures were positive. Among these, 21.4% were Staphylococcus aureus, 14.3% Escherichia coli and 10.7% Klebsiella pneumoniae. Sensitivity, Specificity, Positive and Negative predictive values of CRP in predicting neonatal sepsis were 71.42%, 70.15%, 8.77% and 98.3% respectively. Conclusion C-reactive protein rapid test could not predict neonatal sepsis very well, but might enable to rule out non-sepsis patients because of its high negative predictive value. This is clinically useful for treatment follow-up and antibiotic use.

Rational and Background: Oral disease is an important problem affecting people’s health in Lao PDR, but can be prevented. Pregnant women are more at risk of having oral disease than other groups of people. Oral disease during pregnancy not only affects mothers’ health but also that of babies. Many factors are associated with oral disease during pregnancy, but very few studies were conducted especially in rural areas. Methodology: An analytical, cross-sectional study was carried out from July to September 2012 using close and open questionnaire forms and oral health check up in order to describe oral health status, risk behavior, oral hygiene practice, and factors associated with oral health for pregnant women in three districts of Attapeu Province. Data were analyzed using STATA 10.0 and logistic regression was applied to determine factors associated with oral disease. Results: Five hundred fifty-six pregnant women were studied with a median (range) age of 24 (16-42) years. Most of participants were housewives or famers (78.8%), 62.4% of them with low education level, and 52.0% were Lao-loum (out of 13 ethnic groups). The percentage of the pregnant women who had at least one oral disease was 66.4 %, and the most common oral problems found were dental plaques and carries (53.2% and 10.8%, respectively). Occupation (AOR=2.1 95%CI= 1.4-3.2, P<0.001), ethnic (AOR =2.2, 95%CI=1.5-3.2, P<0.001) and religion (AOR=2.1, 95%CI= 1.4-3.1, P<0.001) were significantly associated with oral diseases during pregnancy. Pregnant women with past and current smoking were 2 times more likely to have oral diseases compared to those who never smoked (AOR=2.1, 95%CI =1.4-3.1, P<0.001). Higher family income (AOR= 0.6, 95%CI= 0.2-0.4, P<0.001) and ANC visits at least once during pregnancy (AOR=0.7, 95%CI=0.5-0.9, P= 0.005) were significant apparent protective factors against oral disease. Conclusion More than half of the pregnant women in rural Laos (Attapeu Province) had at least one oral health problem (mostly dental plaques and carries). Oral diseases were more common in the second than in the first and the third trimester of the pregnancy. Many pregnant women had risk factors associated with oral disease, particularly smoking. ANC visit at least one during pregnancy was associated with less oral disease during pregnancy.