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Bacterial Contamination in Intensive Care Units of a Hospital in Vientiane, Lao People’s Democratic Republic

Panomphanh Mahaphonh ; Ganjana Nathapindhu

Lao Medical Journal.2013;4(4):2-8.

Background and rationale: Intensive Care Units (ICU) are wards where very sick patients are admitted and they are usually connected to invasive devices such as respirator, urine catheter etc. Patients in ICU are more likely (5 – 10 times) to have hospital-acquired infections than those admitted to other wards of the same hospitals. Very little is known about hospital-acquired infections in Laos, including the species of bacterial contaminating ICU. Information on this issue is essential for a hospital to plan on how to manage the environment and set stricter measures to avoid nosocomial infections in the ICU. Methodology: This was a research survey conducted to determine the types and quantity of bacterial contamination in ICUs of a hospital in Vientiane. Open plate technique was applied by placing 256 media plates in 8 rooms of paediatric (n=3) and adult (n=5) ICUs. Controls were closed plates. Plates were sent to and bacteria were identified at National Centre of Laboratory and Epidemiology, Vientiane, Laos. Results: Eight pathogens were identified and the most predominant bacteria found was Coagulase negative Staphylococcus spp. (56.0%), followed by Bacillus spp. (19.7%), Acinetobacter spp. (12.5%), Micrococcus spp. (8.4%), Escherichia coli (1.9%), Klebsiella pneumoniae (0.8%), Providencia rettgeria (0.4%) and Proteus mirabilis (0.3%). Escherichia coli, Klebsiella pneumoniae and Providencia rettgeri were not found in adult ICUs and Proteus mirabilis was not found in paediatric ICUs. The overall mean (95%CI) colonies of pathogens found in paediatric and adults ICUs was 83.04 CFU/dm2 (43.21 - 149.42 CFU/dm2) and 48.54 CFU/dm2 (21.96 - 135.00 CFU/dm2), respectively. Conclusion This study suggested that there were many bacteria contaminated in the ICUs of this hospital with a considerable quantity. Therefore, the hospital should have a better strategic plan to manage its environment and improve sterilization in the ICUs in order to reduce hospital-acquired infections among patients.

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Factors Associated with Oral Diseases Among Pregnant Women in Attapeu Province, Lao PDR

Sysavanh Phommachanh ; Borisouth Phommakhoth ; Mayfong Mayxay

Lao Medical Journal.2013;4(4):9-15.

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.

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Knowledge, Attitude and Practice of Eating and Drinking among Patients with Diabetes Mellitus II at Mahosot Hospital, Vientiane, Laos

Vatsana Thammavongsa ; Benja Muktabhant

Lao Medical Journal.2013;4(4):16-22.

Background and rationale: Diabetes mellitus (DM) remains an important health problem worldwide, including in Laos. Most deaths among DM type-2 patients result from complications due to poor control of glycemia. Eating and drinking behaviors are vital factors for glycemia control in DM patients and study of their knowledge, attitude and practice for eating-drinking behavior may help us to understand the problem and plan engagement and how to promote appropriate changes in patients’ behavior. Methodology: A descriptive, cross-sectional study was conducted to explore knowledge, attitude and practice on eating-drinking of DM type-2 patients who visited the Outpatient Department of Mahosot Hospital from February to March 2012. A questionnaire was designed and pre-tested before interviewing patients following their consent. Patients were selected into the study using systematic random sampling. Results: Two hundred DM type-2 patients (60% females) were interviewed. The overall mean (SD) age of the patients was 58 (9.2) years; 35.5% of them had at least a family member with DM. The mean (SD) duration the patients knew that they had DM was 6.1 years (SD = ±5.8). On the day of interview, 42% and 32.5% of the patients had blood glucose levels that were high (130-180 mg/dL) and very high (>180 mg/dL), respectively. Twenty-two percent of the respondents had a good level of DM diet knowledge while 59% of them had a moderate level and the remainder (19%) had a low level. Most of interviewees (98.5%) had correct knowledge on food restriction (rice, flour, sugar, and lipid) and 93.5% knew that food control, exercise, and taking antidiabetics regularly are the best ways to control blood sugar. Less than 50% of the respondents knew that DM patients have to restrict the quantity of rice to eat and that patients with complications must control their diets strictly. Although 68.5% and 31.5% of the patients had a good and moderate level, respectively, of attitude on DM nutrition, some of them still had beliefs that are not medically recommended. For example, 15.5% of patients thought that they could stop their medication by themselves, 28% said that DM patients can live normally regardless of blood sugar control, and 49.5% believed that DM was a bad karma. Approximately 1/4 of the interviewees reported that they mostly did not eat on time, 30.5% did not restrict their food, 41% just ate what they needed and 41.5% said that they ate any fruits that they liked. Conclusion Although most of DM patients had correct knowledge on DM diets, some of them had attitudes and practice on food consumption, including poor blood sugar control, that are at odds with current medical advice. Engagement methods are needed to inform patients of optimal dietary practice in order to prevent DM complications.

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Motivations Associated with the Performance of Health Staff Who Implemented Strategic Plan on HIV/AIDS/STIs in Two Districts of Vientiane Capital, Lao PDR

Chanthasouk Bansalith ; Chanaphol Sriruech

Lao Medical Journal.2013;4(4):23-29.

Background and rationale: HIV/AIDS is an important and challenging public health problem although Laos has a relatively low infection rate. In order to maintain a low infection rate, the government developed the national strategic plan on HIV/AIDS/STIs prevention. Study on the motivations associated with the performance of health staff who implemented this strategic plan is essential and required so that the results can be used to improve their jobs aimed at maintaining the low infection rate. Methodology: A descriptive, cross-sectional study was conducted with all health staff who were implementing the work related to the national strategic plan on HIV/AIDS/STIs prevention in two districts (Hatxayfong and Xaythany) of Vientiane Capital. A pre-designed and tested questionnaire was used to interview the target sample of 63 people, of these 8 were also interviewed in depth. Pearson Product Moment Correlation Coefficient was applied to detect correlation between different study variables and content analysis was used for data from indepth interview. Results: Of 63 respondents interviewed (females 71.4%), the mean age was 38.4 years, 83% were married, 63% were medical assistants, and 47.6% had working experience between 21-30 years. The overall mean (SD) motivation score of staff was 4.13 (0.40) over 5 while the overall mean (SD) score for job performance was 3.26 (0.59) over 5. Demographic characteristics were not associated with job performance. Motivation factors that were significantly correlated with job performance were respectfulness (r = 0.36, P = 0.01) and job promotion (r = 0.33, P = 0.007). Supportive factors statistically correlated with job performance were salary/incentives (r = 0.32, P = 0.01), professional status (r = 0.31, P = 0.01), and job security (r = 0.43, P<0.001). Obstacles and problems for the strategy implementation found from indepth interviews were discontinuous activity implementation due to insufficient budget, unavailability of campaign materials and medical supplies, some target HIV/AIDS patients not accepting their infection status (difficult to provide them with information) and limited knowledge of some staff. Conclusion Although some factors were significantly correlated with job performance for the national HIV/AIDS/STIs prevention strategic plan, others were also linked to each other and cannot be missed. Therefore, all factors should be integrated during development and improved in order to motivate staff performance aimed at achieving the objectives.

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Effect of Congruence in the Estimation of the Intensity of Pain Between Lao Patients and Their Doctor on Its Control

Phonethépha Phasavath ; Nengyang Wangkou ; Marc Corbière ; Daniel Reinharz

Lao Medical Journal.2013;4(4):30-39.

Background and rationale: No study in Laos has focused on the affects of an accurate estimation by a doctor of his/her patient's level of pain. Methodology: The McGill pain questionnaire was validated into Lao language. The validated version was then administrated to a cohort of 180 new patients as well as to their 88 doctors. The questionnaire was re- administrated to the patients 2 weeks later. Results: A good estimation by a doctor of the intensity of pain felt by his patient is associated with the disappearance of a level of pain that hinders the possibility to carry out daily chores. Three factors were retained in a regression model on the congruence between doctors and patients in the estimation of the pain level: ethnicity and level of education of the patient, and physicians' number of years of practice. Conclusion Teaching future health care providers on how to estimate pain should be considered as a crucial component of medical training.

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Poor-quality medicines: a global threat to health

Chanvilay Sichanh ; Mayfong Mayxay ; Lamphone Syhakhang ; Bounxou Keohavong ; Paul Newton ; Celine Caillet

Lao Medical Journal.2019;10(10):3-11.

Poor quality medicines have been described as a global pandemic that threatens the lives of millions of people. The problem is much more severe in poor-resource countries where pharmaceutical legislation and regulation are limited. Poor quality medicines are divided into three categories: substandard, degraded and falsified and the countermeasures vary according to each category. The use of poor quality medicine leads from minimal to severe complications (including death) for the individuals but also harms the community. Furthermore, they lead to a loss of confidence of the patients in essential medicines, in manufacturers and in health system and they increase the work burden for health workers, customs and police. To detect them, different techniques have been developed, each with advantages and limits. This article describes these aspects of poor quality medicines and also presents the factors that contribute to the existence and spread of poor quality medicines. A section of the article is devoted to the issue of poor quality medicine in Laos.

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Comparing the potential effectiveness of interventions against coronavirus 2019 outbreak in the Lao PDR: a mathematical modeling approach

Phetsavanh Chanthavilay ; Mick Soukavong ; Yu Nandar Aung ; Sai Thein Than Tun ; Lisa Jane White ; Mayfong Mayxay

Lao Medical Journal.2020;11(11):03-7.

This is a policy brief article on the prediction of Covid-19 outbreak and its prevention and control for the possible second wave in the Lao PDR. Compartmental dynamic modeling was created to reflect the natural history of Covid-19. This included susceptible, symptomatic and asymptomatic states and recovery or death. The simulation was done for one year and with two scenarios: 1) high transmission level (R0=5.2) and 2) mid -transmission level (R0=2.0). The model output showed that the size of the outbreak depended on the transmission level, and could reach to 85% of the Lao population with high transmission scenario. However, disease burden was predicted to be smaller with the interventions. Among these, voluntary home quarantine was found to be the most effective, but the predication reverses in the mid-level transmission scenario. Social distancing is much more effective. If there are imported COVID-19 cases, a new wave could occur in two weeks to 2 months, depending on the size of pandemic and efficacy of the rest of interventions. Mid-level lockdown would result in new epidemic starting by July 2020, but the number of infected people would be less if travel bans and social distancing are maintaining. Only high-level lockdown would be able to stop community transmission in the country.

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The health impact of pesticide use in Lao farmers

Khampasith Phommachack ; Tayphasavanh Fengthong ; Vanhphanome Sychalern

Lao Medical Journal.2019;10(10):12-18.

Background and Rational: WHO reported that 735,000 people suffering from chronic disease due to pesticide use. However, no study has been conducted to assess this health burden in the Lao PDR. Therefore, no appropriate strategy was implemented even though pesticide is widely used in Lao PDR. Objective: To study the health impact amongst farmers utilizing pesticides for agriculture in Vientiane Capital. Methodology: The cross-sectional study was conducted in farmers using pesticides. The total number included in the study was 247 people in Hadsayfong and Xaythany Districts. The data were collected from April to June 2017. The data were analysed using Stata version xx. Multiple logistic regression was used to assess the relationship between the health impact and pesticide use. Result: We found that farmers are less educated and used pesticides incorrectly. The proportion of people having small and moderate symptoms were 56.3% and 43.7%, respectively. The factors associated with having symptoms were larger household size (Adjusted Odd Ratio =1.9; 95%CI= 1.0-3.6; P-value = 0.02), using pesticide longer than 3 hours each occasion (AOR=4.8; 95%CI= 2.6-8.9; P-value < 0.001), and using pesticide more than 8 times per month (AOR=0.5; 95%CI= 0.2-1; P-value = 0.01). Significant factors associated with not having symptoms included using materials to stir pesticide (AOR=0.5; 95%CI= 0.2-1; P-value=0.002) and wearing masks during pesticide spraying (AOR=0.4; 95%CI= 0.2-0.7; P-value=0.004). Conclusion and recommendation The study found that the knowledge of farmers towards pesticide’s side effects was mostly low with incorrect use. Without any appropriate education, farmers risk of suffering from chronic diseases such as cancer and dermatological diseases.

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Prevention of Metamphetamine Use Relapse Through Improving Effective Information, Education and Communication (IEC): An Open Cluster-Randomized-Controlled Trial

Sysavanh Phommachanh ; Soudavanh Soysouvanh ; Oukeo Keovoravong ; Mayfong Mayxay

Lao Medical Journal.2019;10(10):19-27.

Background and Rational: In Lao PDR, relapse of metamphetamine use following discharge from rehabilitation center is unacceptably high (~50%). Good preparedness and IEC provision to the rehabilitated addicts before discharge from the rehabilitation center is likely to be vital to prevent relapse. Effective IEC would probably help to reduce the rate of relapse. Methodology: This was an open cluster-randomized-controlled trial to assess the newly developed IEC package among metamphetamine users. The intervention group received new IEC package (education message + brochure + telephone contact number + follow-up) while the conventional advice was given to control group. The study participants were followed up for 6 months by telephone (at 1, 3, 6 months). The primary endpoint was the relapse rate. Result: One hundred and eighty-one addicts were enrolled in the trial (93 in intervention and 88 in control groups). Ninety-six subjects were male. The overall mean (SD) age of the participants was 26.5 (6.1) years and the overall median (range) duration of drug use was 5 (0.5 – 26) years and these figures were not significantly different between the groups (P=0.50 and P=0.97), respectively). The proportion of the participants who were lost to follow-up was 8%. Sixty percents of the study subjects completed 6-months follow up and this was not statistically different between the groups (P=0.93). The overall percentage of relapse was 39% (65/166) [36% (31/85) in intervention and 42% (34/81) in control groups, P=0.38). The median (range) duration of relapse was 30 (1 – 160) days and this was not significantly different between the groups (P=0.38). In a multiple logistic regression model, contact with drug users following discharge from the rehabilitation center was significantly associated with relapse [AOR = 73, 95%CI = 39 – 405, P<0.001] while having a permanent job following discharge was a protective factor for relapse [AOR = 0.03 (0.004 – 0.27), P=0.002]. Conclusion The relapse rate of metamphetamine use was lower in the group with new IEC package than in control group but this was not statistically significant. Further study with a larger scale is strongly recommended

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Job satisfaction of the Nurses at Emergency Ward of Mahosot Hospital

Dasavanh Bounmany ; Aphone Vixathep

Lao Medical Journal.2019;10(10):28-37.

Background and Rational: Improving quality of services is one of the main strategies of the Ministry of Health to strengthen health care services, aiming to provide better care. The Emergency Ward (ER) of Mahosot Hospital provides services to patients 24 hours a day. Since the work there is very busy, some complaints were arisen from the nurses regarding the workload, insufficient staffing levels, and staffs did not have time for families. In addition, three nurses asked to change their jobs and 6 ask to move to another ward. We, therefore, conducted this study to assess job satisfaction of the nurses and obstacles in regards to their work and management. Methodology: A descriptive cross-sectional study was conducted from 19-25 February 2018. Thirty-three nurses working in ER were interviewed using pre-designed and pre-tested questionnaire comprising 4 parts. Data analysis was done using SPSS. Result: The mean age of the respondents was 34.3 years, 85% were female and 73% were married. Nearly half of them did not have children. Thirty-nine percent of them have worked for 6-10 years with 73% having a nursing degree. The majority of them are satisfied with their current work (90.9 %) and 79% of them said that they had a great job with appreciation from their colleagues. More than half had the appropriate opportunity for short-course training and support from the head of department. Observing their practice, we found that they had clean nursing uniform (66.7%), showed appropriate behaviors (54.5%), friendly service (54.5%) and had good relationships with their colleagues (63.6%). Regarding the obstacles and solution, they reported that some problems need to be solved including those related to human resource (90.9%), relationships with other nurses (21.2%), head nurses (9%), doctors (27.16%), nature of workplace and environment (63%), facility and management (27%), equipment and medicine availability (72.7%), remuneration (51.5%) and others (30%). Conclusion The job satisfaction level of the nurses at ER of Mahosot Hospital is high but there remain some concerns related to work safety, working environment, equipment and salary. Therefore, it is vital that these problems should be solved urgently in order to strengthen quality of health care service.

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