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Examining the Impact of Aging and Interventions towards Burden of Diabetes Mellitus in Lao Population: A Model-Based Study

Phouthapanya Xongmixay ; Mayfong Mayxay ; Phetsavanh Chanthavilay

Lao Medical Journal.2021;12(12):03-13.

Background: Diabetes Mellitus (DM) is a major public health concern, but with minimal data on how this affects the Lao population. Objective: We aimed at predicting the impact of the burden of DM, and determine the effectiveness of DM screening techniques to reduce related mortality in Lao PDR. Methods: A compartmentally deterministic model was created to reflect the demography in 2005 and 2015, and DM prevalence in 2015 of the Vientiane capital population. The parameters were retrieved from calibration and literature reviews. The model predicted demographic structure and DM in 2035. The effectiveness of DM screening tests, either Fasting Plasma Glucose (FPG) or glycated hemoglobin (HbA1c), was examined in term of mortality reduction. Results: By 2035, the Vientiane population is expected to have annual grow of 0.89% with higher proportion of more elderly people; those aged 45 years old and older are expected to account for 39.3% in 2035. Overall prevalence of DM was expected to rise from 9.65% in 2015 to 13.4% in 2035 as a result of the aging population. The model predicts that the prevalence of DM would double (28.42%) in those aged >60 years old by 2035. The mortality rate is expected to increase more than double from 890 in 2015 to 1,808 deaths per 100,000 people in 2035, with the highest rate in those with undiagnosed diabetes and those older than 60 years. Screening by FPG test at an initial age of 35 years old is estimated to reduce mortality by 17.93%, and 16.80% for initial age screening at 45 years. Screening by HbA1c test would slightly increase the mortality reduction by approximately 1.20% at both initial screening ages. Conclusion This mathematical modeling projected the steadily increase of prevalence and death related to DM over 30 years of simulation. Early screening by glycemia would reduce the mortality.

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Knowledge, Attitude and Practice towards cervical cancer screening among healthcare providers in Luang Prabang and Salavan Provinces, Lao PDR

Souksavanh Sysamay ; Phonepasong Aye ; Sengchanh Khounnavong ; Phimpha Paboriboune

Lao Medical Journal.2021;12(12):14-21.

Objective: we aimed to assess the knowledge, attitude and practice (KAP) of healthcare providers (HCP) towards cervical cancer (CC) screening and to identify possible factors associated with its low utilization among women presenting at gynaeco-obstetrics units in the Lao PDR. Methods: A cross-sectional study was conducted between March - June 2018 on a sample of 85 (HCP) at gynaecology units in two provincial and eleven district hospitals in Luang Prabang (LPB) and Salavan (SLV) Provinces. Results: Of the 85 HCP, 63.4% were from SLV and 36.6% from LPB. 81% were females and mean ager was 32 years. Only 7% of them had good knowledge, 18.8% had good CC screening attitudes and only 1.2% had good CC screening practices. 36.2% of female HCP had been screened for CC and 48.3% had not been screened because they thought only those who had symptoms and risk factors should go for. The most common reasons for not conducting routine CC screening of patients were: lack of medical equipment (53.7%), and incompetent techniques (43.3%). HCP graduates and post graduates had a higher knowledge score (aOR = 4.09, 95% CI: 1.43-11.66, P = 0.008), and attitude score (aOR = 5.54, 95% CI: 1.55-19.75, p=0.008). Those, who had been working for more than 10 years, were more likely to have higher attitude scores (aOR = 6.07, 95% CI: 1.36-27.15, p =0.018). Conclusions: CC screening knowledge among HCP is generally fair. However, CC screening attitudes are still poor. Re-orientation courses on CC screening for HCP are urgently needed in order to move forward to the next steps in CC screening programs.

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Suboptimal knowledge of hepatitis B infection and concerns regarding HBV vaccination among blood donors in Lao People’s Democratic Republic (PDR)

Emma Pollack ; Khamfong Kunlaya ; Chirapha Keokhamphoui ; Chanthala Souksakhone ; Phetsavanh Chanthavilay ; Somphou Sayasone ; Antony P. Black ; Phonethipsavanh Nouanthong

Lao Medical Journal.2021;12(12):22-30.

Background: There is a high prevalence of HBsAg in adults in Lao PDR, as seen in first-time blood donors. The high positive rate is also detected in repeat donors although the cause is unclear. By surveying blood donors, this study examines the general population’s knowledge level of HBV infection and assesses the public’s perception of vaccination. Objective: The aims of this study were to assess knowledge, attitude and practices (KAP) of blood donors regarding HBV infection. Methodology: We conducted a cross-sectional study to collect the KAP information among consenting students of high school and university in March-September, 2018. A self-answered questionnaire was also utilized among blood donors in Vientiane Capital, Luang Prabang and Khammuan Provinces. The questionnaires were distributed and completed in the classroom setting with investigators proctoring. Descriptive analysis was performed on the socio-demographic characteristics, Student’s T-test were performed to examine the difference of mean and linear regression models the association between dependent and independent variables. Results: Among 625 blood donors (132 health science students and 477 non-health science students), all had a positive attitude towards blood donation, but they had low knowledge towards hepatitis infection and prevention. Multivariable analysis showed that x factors were significantly associated with HBV vaccination. This included gender, level of education, being a health science student, HBV positivity status and awareness not to donate blood and knowledge towards vaccination. HBV vaccination hesitation was observed in blood donors who did not know that vaccination can prevent infection, and most blood donors (76.9%) answered that they were healthy so did not see the need for the vaccine and did not understand this vaccination method as prevention. A fear of injections, belief that they would not be able to drink alcohol for two weeks surrounding vaccination and that it was not necessary to prevent HBV infection were reasons given to not seek HBV vaccination. Conclusion Blood donors had overall poor knowledge on hepatitis B infection and prevention, particularly among the non-health student donors. Blood donors should be aware of and understand their HBsAg testing status and broaden their perception and knowledge on HBV infection and prevention.

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Evaluation of preterm and low birth weight morbidity, mortality and standards of care in Lao PDR

Buasaengniyom Phrasidthideth ; Alongkhon Phengsavanh ; Pakaphan Kiatchoosakun

Lao Medical Journal.2021;12(12):31-40.

Objective: we aimed to investigate the possible causes of death among preterm and LBW infants admitted to the post-delivery ward and/or NICU at Mahosot Hospital, Lao PDR, and the possible factors that influence preterm and LBW infants’ survival. Methods: A retrospective cross-sectional study was conducted between by reviewing the treatment and outcomes for preterm and LBW infants admitted July - November 2017 to Mahosot Hospital in Vientiane, Lao PDR. Results: Of 3,500 births in 2017, 224 (6.4%) were preterm, 350 (9.4%) were LBW and 106 (30.2%) were term LBW; 98 preterm births (43.8%) and 21 (19.8%) term LBW babies were admitted to the NICU. Enrolment included 93 cases including 86 (92.5%) preterms and 7 term LBW neonates, of whom 47 (54.7%) and 2 were admitted to NICU, respectively. Enrollees were mostly male, Lao Loum, born vaginally at Mahosot Hospital; 3.2% were extreme preterm, 15.1% were very preterm, 74.2% moderate to late preterm and 7.5% term LBW; 2.2% were extremely LBW, 16.1% very LBW, 63.4% LBW and 18.3% normal birth weight. All 44 (47.3%) preterm or LBW babies admitted to the postnatal ward survived. Of the 49 (52.7%) admitted to the ICU, 18.4% died. All neonates who died were preterm of gestational age ranging 25-36 weeks and birth weight 730-2220g. Babies admitted to the NICU were mostly diagnosed with respiratory distress syndrome (RDS, 39.7%), neonatal infections (31.7%), asphyxia (9.5%) and congenital malformations (4.8%). Patient care. Antenatal: 5.9% of preterm births <32 weeks received magnesium sulfate, and 27% of births 24-34 weeks gestational age received antenatal steroids. Postnatal: 37.6% received skin-to-skin contact (SSC), and 15% maintained SCC until breastfeed completed, 68.8% received exclusive breastmilk as first feed and 24.5% kangaroo mother care. Only 7.5% were monitored for hypoxemia and 24.7% for hypothermia. Weights were not checked prior to discharge. Case management: Around two-thirds of babies with risk factors for sepsis received prophylactic antibiotics. Most (77.6%) babies during the NICU admission received antibiotics, all of whom had a CBC and blood culture; but half without a diagnosis of sepsis or risk factors. Most (79.6%) preterm and LBW babies admitted to the NICU were given oxygen. About one-quarter of babies with RDS died. Very LBW infants rarely received supplementation with vitamin D, phosphate, iron and calcium. Conclusions Most study participants were late preterm and LBW. Just under 10% died. Care can be improved, including antenatal administration of magnesium sulfate and antenatal steroids that needs to be vastly increased for eligible mother in preterm labor. Respiratory management needs further investigation for gaps. Feeding with breastmilk and checking vital signs appear to be strengths.

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Evaluation of Village-level Childhood Immunization Coverage in the Lao People’s Democratic Republic: Measles as indicator?

Phouthapanya Xongmixay ; Mayfong Mayxay ; Soudavanh Soysouvanh ; Vanhpheng Chanphothong ; Alouny Meksithong ; Nith Manhavong ; Ko Chang ; Thipphaphone Phommalath ; Leeyounjera Yang ; Phetsavanh Chanthavilay

Lao Medical Journal.2021;12(12):41-52.

Background: Outbreaks of vaccine preventable-disease control and elimination are impeded by impaired focal vaccination uptake. Therefore, we aimed at assessing vaccination uptake and comparing with passive surveillance (PS) report at village level. Methods: A community-based cross-sectional survey was conducted in the villages covered by two health centers in Bolikhamxay province, including non-Hmong and Hmong ethnic groups. Data collection was conducted by interviewing mothers or caregivers of children aged 6 to 23 months. The vaccination status was identified by vaccination cards, and compared with PS report at village level, which was collected from health centers. The Pearson’s chi-square test was used to compare these proportions, and pairwise correlation was used for the correlation of observed vaccination coverage. Finding: Sixteen villages were included, nine were from Luk52 health center area and 7 from Namkhou health center area. There was a significantly strong correlation for pentavalent pneumococcal conjugate vaccine, Japanese encephalitis, Measles and Rubella and full immunization coverage compared to others. This correlation was not observed in the non-Hmong population. Amongst non-Hmong, the recorded coverage was lower in PS than in the survey regardless of type of vaccine. In contrast, amongst Hmong most vaccines had higher recorded coverage in PS than in the survey except Bacillus Calmette–Guérin (BCG) and hepatitis B at birth dose. MR and JEV vaccine, commonly given at the same time, were the only one that did not have significantly different coverage between PS and the survey (p<0.334). Conclusion The mis-estimatation of immunization coverage from the PS reporting system highlights further research needed to determine a better indicator of village-level vaccination coverage, but measles could be an indicator of prioritizing the settings.

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Performance of three commercial rapid diagnostic tests for the detection of hepatitis B surface antigen (HBs Ag) in Lao PDR

Dalouny Sihalath ; Philavanh Sitbounlang ; Sengdao Vannarath ; Bouachanh Rasachak ; Myfong Mayxay ; Sté ; phane Bertani ; Eric Deharo ; Phimpha Paboriboune

Lao Medical Journal.2021;12(12):53-58.

Objective: This study aimed to determine sensitivity, specificity, and accuracy of RDT used in 4 health care centres in Vientiane capital versus ELISA. Methods: A study was then conducted among 1,729 patients who underwent three different RDTs for surface antigen of hepatitis virus (Boson, CTK and Coretest) in two public central hospitals and two private clinics in Vientiane Capital, to compare sensitivity, specificity, and accuracy of RDTs versus ELISA. Results: The mean age (95%CI) of the patients was 28.7 years old and the sex ratio was balanced. 13.71% of the patients had positive HBsAg as detected by ELISA, while this was only 8.9% for RDTs. All three types of RDTs had a sensitivity of 54% and specificity of 97%. There was no difference in accuracy, sensitivity, specificity, positive and negative predictive values between RDTs. Conclusions This study revealed higher prevalence of HBsAg among young adults who were present in health care facilities in Vientiane than previously described in Laos. All three RDTs studied had low sensitivity but high specificity; therefore, they are likely to miss many cases of Hepatitis B infection and should be replaced or backed up by more accurate methods.

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Migrations and HIV transmission as experienced by people living with HIV in Lao PDR

Zanarath Phanoula ; Xayalath Xayasith ; Siladouangchay Praphad ; HANCART PETITET Pascale

Lao Medical Journal.2021;12(12):59-66.

Objective: The aim of this paper is to assess the interactions between migration paths and HIV infection risks among and from the views of people living with HIV in Lao PDR. Methods: Twenty-four in-depth interviews with eight interviewees were carried out by four trained members of the Association of People Living with HIV (APL+), in 2017. The qualitative analysis was done manually to explore the influence of social determinants through migratory paths on the evolution of individual lifestyles, working and living environments, access to information, prevention and healthcare that contribute to HIV infection risks. Results: Low levels of economic and education lead to migration and also increase risky practices and vulnerability to HIV infection of migrant workers. Insufficient awareness and access to prevention against HIV/STIs in their home country increase risky behaviours during migration. Moreover, inadequate referral system for HIV treatment, stigma, and family relationships contribute to influence the life courses of migrants' post-HIV infection. Conclusions Raising awareness and providing access to information on HIV/STIs, both for internal and external migrant workers are crucial in order to diminish the prevalence of HIV infection among the target audience. A reinforcement of the existing collaborative health measures between Lao PDR and Thailand is needed to enhance migrants’ access to healthcare services.

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A pilot study to investigate the risk of SARS-CoV-2 household transmission following hospital discharge of confirmed cases in Vientiane Capital, Lao PDR

Mayfong Mayxay

Lao Medical Journal.2021;12(12):67-70.

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.

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Oral squamous cell carcinoma of the tongue in a young Lao patient: a rare case report and literature review

Viengsavanh Inthakoun ; Maiboun Simalavong ; Anhtana Potsavang

Lao Medical Journal.2021;12(12):71-73.

Oral cancer has been regarded as disturbingly high and diagnosed mostly among males, with median age at the diagnosis of tongue cancer was 61 years, with only approximately 2% of patients under 35 years old. Oral squamous cell carcinoma is rare in young age groups, and may misdiagnosed resulting for late treatment leading to poor survival rate. We report the case of a 27year-old Lao woman with tongue cancer in the lateral posterior border area.

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Granulocytic sarcoma of the breast: A case report in Lao PDR

Phaengvilay Xaysomphet ; Bounleng Kousonh ; Soulideth Vilayvong ; Thitsamay Luangxay ; Phetsamone Alrounlansy ; Motoji Sawabe ; Moosa Khalil

Lao Medical Journal.2021;12(12):74-77.

Granulocytic sarcoma (GS) also known as myeloid sarcoma, chloroma, myeloblastoma, or extramedullary myeloid tumor is a neoplasm composed of immature myeloid cells. The common sites of involvement include bone, central nervous system, soft tissue, lymph nodes, and skin. The involvement of GS in breast tissue is very rare. The incidence of breast GS is 2/1,000,000 in adults. Those affected range in age from 16 to 72 years, with the mean age of 31 years. Primary, isolated, or non-leukemic GS of the breast is defined when bone marrow biopsy confirms the absence of other hematologic malignancy. We here report a case of granulocytic sarcoma of the left breast in a 33 year-old woman who presented with a breast mass. She was initially diagnosed as having diffuse lymphoma, large cell type on Hematoxylin and eosin stain (H&E) histopathology. The tumor cells were, however, strongly positive for myeloperoxidase (MPO), CD117, CD34, and CD43 but negative for CD45, CD20, CD3, or cytokeratin. Although further clinical information, such as complete blood count or aspiration biopsy of bone marrow tissue, was absent, we finally diagnosed this case as GS by additional immunohistochemical study. What happened to the patient?

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