Background:: Eczema, also known as atopic dermatitis, is a chronic relapsing inflammatory skin disease characterized by defective skin barrier function. Laos is a low resource setting located in South East Asia region which very few studies related to skin health have been conducted. Objectives: : This study aimed to clinical Screening and Treatment of Eczema: A Prospective Study among Children under 5 Years Old Presenting to Children’s Hospital, Setthathilath Hospital and Mahosot Hospital, Lao PDR Methodology: : This study was a descriptive cross-sectional design study, conducted from May to November 2023. In all, 478 children attended OPD with a skin complaint. Children visited the Outpatient department in Children’s Hospital, Setthathilath Hospital, Mahosot Hospital, of whom 208 children diagnosed with eczema were included in study. Results: : Among 208 children, 130 (62.5%) had flexor involvement and 78 (37.5%) had extensor involvement. The main drugs used for treatment were emollient cream and topical corticosteroids in 157 (75.48%) From a clinical point of view, these findings are often a source of parental anxiety and medical concern for in experienced clinicians. Conclusion: Eczema (atopic dermatitis) in Lao children is often a source of parental anxiety and presents management challenges for in experienced clinicians, correct diagnosis and parental counselling may relieve anxiety. General paediatricians should be able to reassure parents of children with eczema and manage skin lesions using emollients and topical corticosteroids.

Background: : Traditional medicine encompasses the collective knowledge, skills, and practices based on cultural theories, beliefs, and indigenous experiences. While herbal and traditional medicines are widely used, caution is warranted, particularly regarding products promoted by social media or the internet; as some are unregistered and may lack efficacy or safety. Knowledge derived from traditional healers can be valuable, yet is information and improper use remain concerns. Objective: : This study aimed to assess the experience and perception of herbal and traditional medicine use among residents in Vientiane Capital, Lao PDR. Methodology: : A cross-sectional survey was conducted from September to December 2023 in four villages across two districts of Vientiane Capital, selected via simple random sampling. Structured interviews were administered to 291 participants to collect data on their experience and perceptions regarding traditional medicine utilization. Results: : Of the 291 respondents, 268 (92.1%) reported experiencing illness within the three months preceding the interview. Among these, 92.54% reported using traditional medicine (TM) for treatment. The majority perceived TM as effective, safe and compatible with modern medical treatments. Statistical analysis demonstrated a significant association between the perception of TM as safer than modern medicine and its usage. Conclusion: Herbal and traditional medicines are commonly preferred as first-line treatments in accordance with government policy. These findings underscore the importance of promoting the correct and appropriate use of traditional medicine to optimize health outcomes.

Background:: Food taboos during pregnancy can have both positive and negative impacts on maternal and fetal health. While food provides essential nutrients necessary for pregnancy, certain traditional beliefs lead to the avoidance of specific foods. Objectives: : to assess the nutritional status of pregnant women, identify commonly avoided foods, and explore the reasons behind food taboos. Methodology: : A cross-sectional study was conducted with a sample of 366 pregnant women at ≥ 20 weeks of gestation. Data were collected from January to December 2023. Data collection included four components: sociodemographic characteristics, food taboo practices, reasons for food avoidance, and nutritional status. Interviews were conducted using strutted questionnaires, and additional notes were recorded. Data analysis was performed using SPSS statistical software version 23 using descriptive analysis (number and percentages). Results:: The prevalence of food taboos among pregnant women was 48% (174366). Commonly avoided foods included beef, frogs, insects, goat meat, chicken, fish, balut, sea ood, honey, milk, dried buffalo skin, kha vegetables, kao thong vegetables, papaya, kaolame (sticky rice inside the bamboo), and durian fruit. The main reasons for food avoidance were traditional beliefs, concerns about fetal health, fears of difficult labor, perceived risks to maternal health, and concerns about stillbirth. Additionally, some women avoided certain foods due to personal dislikes or allergies. Regarding nutritional status, the majority of pregnant women experienced normal weight gain (59.6%), while 25.4% had mild weight gain, and 15.0% had low weight gain. Conclusion: Pregnant women must balance their nutritional needs with traditional beliefs that have been passed down through generations. Nutritional interventions and counselling should be designed with cultural sensitivity, incorporating local knowledge and the influence of community leaders. Additionally, healthcare providers should be trained to address food taboos in a way that promotes maternal and fetal health.

Background: : Stroke is the first leading cause of death in Lao PDR. In the last ten years, deaths as a result of stroke have increased by 19.5 %. We hypothesized that the global COVID-19 pandemic caused people living with non-communicable diseases to become more vulnerable to becoming severely ill or dying, with a delayed presentation to the Emergency Department and increased stroke severity. Objectives: : To understand the experience for the care service in outpatient department (OPD) visits of patients with stroke before and during the Covid-19 pandemic in Lao, PDR. Methodology: : We conducted a cross-sectional study of patients with stroke who were followed up at the Stroke OPD clinics in three central hospitals from April to October 2023 to explore their experiences of care before and during the pandemic. Results: : Among 294 patients, 59.9% were male, and the mean age was 59.5 years (SD 11.9). Almost all (96.9%) of them had been vaccinated against COVID-19. Most (68.4%) reported that they had been affected by factors related to the pandemic when they attended OPD clinics (process/steps of service, number of staff, communication, and social distancing). Participants reported they most valued being seen by a specialist at their follow-up appointments. When comparing the service before and during the pandemic, they noted that staff numbers went down during COVID-19. They were also obliged to test for COVID-19 before appointments. To improve the service in a similar situation in the future, they recommended better communication and health education by using posters and having a process to fix a queue. Conclusion: Stroke services need to consider pandemic preparedness to optimize service delivery for patients in a future pandemic situation.

Rationale and Background: : Breastfeeding (BF) is considered an effective way to provide balanced nutrition, better growth, and development of the infant, prevent stunting as well as protect from infectious and chronic diseases. WHO and UNICEF recommended exclusive BF (EBF) for the first six months of age and giving no other food or drink to the infant during this period. The government of Lao PDR has launched several strategies and policies in an effort to improve exclusive breastfeeding since 2006. The EBF Campaign was strongly promoted during 2009-2010 to improve child survival rates and enhance the development of children by increasing the number of mothers who EBF their newborn for six months. Methodology: : This study was conducted in two provinces in Lao PDR. A cross-sectional analytical study design was applied in this study to examine the prevalence of EBF duration and identify the factors associated with EBF duration. The sample size estimation was 710 mothers. Probability random sampling using a multi-stage sample technique was used. Data were collected through a face-to-face interview in the household. The median duration and 95% CI of BF was derived using Kaplan-Meier survival curves, and multivariable Cox proportional hazards (PH) models were performed. Results: : Out of 710 mothers, the age of study participants was between 15 and 45 years; the mean age and SD were 27.3 ± 5.8 years, and almost all of them (97.2%) were married. 75.4% members were Lao Ethno-linguistic group, 50.8% were educated at high school, and 43.1% of participants were housewives. 53.3% of her husbands stayed at high school, and 49.4% of them took on the occupation of farmer or agriculturalist. 57.9% were classified as exclusive breastfeeding; the median duration of breastfeeding was 12 months; 40.1% were breastfeeding for 7–12 months. Factors significantly associated with breastfeeding duration included the number of prior pregnancies, age at first pregnancy, whether a postnatal check was conducted after hospital discharge or home birth, child’s weight, and child’s height. Conclusion: Breastfeeding duration is influenced by a variety of factors, including the number of previous pregnancies, age at first pregnancy, postnatal health check-ups, the child's weight, and maternal knowledge about breastfeeding. Understanding and addressing these factors is crucial in promoting successful and sustained breastfeeding among mothers, ultimately leading to improved health outcomes for both mothers and children.

Introduction: : Most of the children in Laos who are infected with the human immunodeficiency virus (HIV) contract it through perinatal mother to child transmission (PMTCT). One major risk factor for this transmission is the maternal viral load during the peripartum period. Consequently, the maternal risk classification for MTCT, based on maternal viral load, duration of antiretroviral treatment (ART), and adherence, has been widely used but has not been universally applied in Laos. Objectives: : To evaluate the maternal clinical risk classification and perinatal mother to child transmission at Mahosot and Setthathirath Hospital. Methodology: : This retrospective descriptive study was conducted at the Infectious Diseases Department of Mahosot and Setthathirath hospitals in Vientiane Capital, Laos, from January 2016 to December 2020. Data were analysed using SPSS version 26. Results: : A total of 430 HIV-infected mothers were included in the study, with 299 (69.5%) being newly diagnosed, and 251 (58.4%) identified during pregnancy. According to the WHO classification, 70.9% were at stage 1 (asymptomatic). Among pregnant mothers, 62.1% were on the tenofovir/lamivudine/dolutegravir regimen, while 37.9% were on zidovudine/lamivudine/nevirapine. All 430 infants received zidovudine (AZT) or AZT + nevirapine as postpartum prevention, with 259 (60.2%) completing 4 weeks of AZT. In terms of risk classification, 257 (59.8%) mothers were categorized as standard risk. Overall, 53 out of 430 (12.3%) children were diagnosed with HIV infection at 18 months of age. The MTCT rate was 3 out of 257 (1.2%) for mothers in the standard-risk group and 50 out of 173 (28.9%) for those in the high-risk group. Conclusion: The HIV PMTCT rate in Laos remains high, especially among HIV-infected mothers at high risk. Therefore, early detection of HIV infection, prompt initiation of ART in HIV-infected pregnant women, and the use of risk classification to select postpartum prophylaxis regimens are crucial steps in reducing the number of new HIV-infected infants in Laos.

Background: : Cancer patients with febrile neutropenia (FN) at risk of life-threatening sepsis, and require immediate empirical antibiotic therapy. Appropriate empirical therapy is a key factor for the management. 48% to 60% of childhood cancer patients with FN have infections. Bacteremia was found in 10-50% of all patients with febrile neutropenia. Objective: : To investigate the causative bacteremia Pathogens in children with cancer during febrile neutropenia at children hospital, Vientiane, Lao PDR. Methods: : A cross-sectional descriptive study was conducted to investigate the bacterial pathogens responsible for febrile neutropenia (FN) in children under 15 years of age undergoing chemotherapy for cancer. The study was carried out at the Department of Pediatric Hemato-oncology, Children's Hospital, Vientiane, Laos, from October 2021 to September 2022. Results: : A prospective study involving 162 FN episodes was undertaken. The most prevalent underlying malignancy was acute lymphoblastic leukemia (ALL), accounting for (78.40%) of cases. Clinical presentations associated with FN included pneumonia 21%. Febrile neutropenia without an identified source accounted for 58.02% of FN episodes. Severe neutropenia was observed in 59.88% of FN episodes. The frequency of bacteremia was 19.14%. Gram-negative organisms constituted 83.87% of infections, with E. coli being the most frequently isolated pathogen 29.03%. Other gram-negative organisms included Klebsiella pneumoniae, Pseudomonas aeruginosa, Burkholderia pseudomallei, and Acinetobacter baumannii. Fifty percent of E. coli and K. pneumoniae exhibited extended-spectrum beta-lactamase (ESBL) production. All ESBL-producing organisms were susceptible to meropenem and amikacin. Gram-positive organisms accounted for 16.13% of infections, with methicillin-resistant Staphylococcus aureus (MRSA) being the most prevalent 6.45%. Half of the Gram-negative organisms showed sensitivity to ceftazidime, and they were all 100% sensitive to aminoglycosides, particularly amikacin and meropenem. Conclusion: Within the context of febrile neutropenia, the frequency of bacteremia was found to be 19.14%. The most common primary causative organism was E. coli. Based on these findings, we recommend that for low-risk patients with FN, the initial empiric antibiotic regimen should consist of ceftazidime and amikacin. For high-risk patients or those hospitalized for extended periods, the most suitable empiric antibiotic regimen is meropenem combined with amikacin.

Background: : Congenital heart disease (CHD) is the major congenital anomalies, representing for one - third of all congenital anomalies and also leading cause of death in infants. Asia reported the highest CHD birth prevalence with 9.3 per 1,000 live births. Delayed diagnosis of congenital heart disease worsens preoperative condition and outcome of surgery in neonates, increased rates of cardiovascular compromise and end organ dysfunction the later CHD was recognized. Early detection of major congenital heart disease might improve the outcome of newborn babies Objective: : To determine the congenital heart disease (CHD) by pulse oximetry with clinical assessment screening in asymptomatic term neonates at Mother and Newborn Hospital in Vientiane Capital, Lao PDR. Methodology: : During the cross-sectional study, from July 1st, 2023 to August 30th, 2023 to investigate pulse oximetry with clinical assessment screening in newborn 24-72 hours of life at OPD nursery Unit, at Mother and Newborn Hospital in Vientiane Capital, Lao PDR from July 1st, 2023 to August 30th, 2023. Results: : A cross-sectional study involving 600 asymptomatic term newborn babies. The diagnosis congenital heart disease 11 of 600 cases (1.83%), 3 cases were critical congenital heart disease. Median age screening was 24 hours (ranged 24-72 hours) and the mean +/- SD was 31.80 +/- 11.18. Normal delivery was 80.5%. The median birth weight was 3000 grams (2100-4200). The gender was 50.3% female. Pulse oximetry with clinical assessment screening in positive was 1%, pulse oximetry alone was 0.5% and clinical assessment was 0.33%. Pulse oximetry with clinical assessment was detected 5 of 11 cases (45.45% sensitivity) of all congenital heart disease and 3 of 3 cases (100% sensitivity) of critical congenital heart disease, pulse oximetry alone was detected 3 of 11 cases (27.27% sensitivity) of all CHD and two of three cases (66.67% sensitivity) of critical CHD, clinical assessment alone was detected 2 of 11 cases (18.18% sensitivity) of all CHD and one of three cases (33.33% sensitivity) of critical CHD. The specificity of using pulse oximetry with clinical assessment was 99.83% for all CHD and 99.50% for critical CHD, pulse oximetry alone was 99.83% for both all CHD and critical CHD, and clinical assessment was 99.83% for all CHD and 99.50% for critical CHD. Conclusion: Pulse oximetry with clinical assessment screening is more effective at early detection of critical congenital heart disease in asymptomatic term newborns. It has good sensitivity and specificity for both critical and non- congenital heart diseases, including challenging cases that required urgent intervention. These findings suggest that pulse oximetry with clinical assessment screening should be used routinely to screen all newborns for congenital heart disease.

Background: : Neonatal sepsis is the most common cause of neonatal mortality in Lao PDR, however, there are limited contemporary data on the incidence of early-onset sepsis in Lao PDR. Antibiotics are most commonly used in intensive care units and intermediate care unit for maternal risk and clinical signs of early-onset neonatal sepsis. Objectives: : To describe early-onset neonatal sepsis by clinical signs, laboratory results, and antibiotic usage in neonates admitted to Mother and Newborn Hospital and Mahosot Hospital in Vientiane, Lao PDR Methodology: : This study is a descriptive study of neonates admitted within 3 days of life, early-onset neonatal sepsis was defined as a neonate who presented with two or more clinical signs or laboratory results suggesting sepsis and received antibiotics for at least 3 days. Results: : Among 500 cases the common clinical presentations of EOS are oxygen requirement or need for ventilation support in 304 infants (60.8%) temperature instability in 223 infants (44.6%) and increased serum bilirubin in 154 infants (30.8%) There were 13 infants (2.6%) diagnosed with culture-proven sepsis from positive blood culture. The causative organisms were predominantly gram-negative bacilli such as Escherichia coli, and Acinetobacter baumannii, and gram-positive cocci such as Staphylococcus aureus, and Group B Streptococci. The rate of antibiotic usage is very high, ampicillin was prescribed in 489 (97.8%) and gentamicin in 438 infants (87.5%), the duration of antibiotic therapy was 5 to 14 days. Conclusion: The rate of culture-proven early-onset neonatal sepsis was low, but there was a very high rate of antibiotic usage. Antibiotic stewardship should be strongly emphasized.

Rationale and Background: : Hepatitis B virus (HBV) vaccine has been developed in early 1980s and shown good efficacy. However, children with HIV infection had poor immune response to many kinds of vaccines. Objectives: : To assess the persistence of vaccine immunity against HBV after the primary vaccination in infancy and the response to revaccination in HIV-infected children in Mahosot hospital. Methodology: : This study was prospectively conducted in HIV-infected children at Mahosot hospital from September 2021 to August 2022. Seventy HIV-infected children were enrolled. Inform consent was performed before starting the study. Anti-HBs was checked, if anti-HBs≥10 mIU/mL, the subjects would not receive booster dose for Hepatitis B vaccine. If anti-HBs<10 mIU/mL, the patient will receive one booster dose and checked for anti-HBs 4-8 weeks after. If anti-HBs was still<10 mIU/mL, another 2 booster doses will be given and anti-HBs is checked 4-8 weeks after. Results: : We enrolled 70 HIV-infected children, most of them were older than 10 years (median=12.5). The mean age at diagnosis of HIV was 2.9 years. Sixty-seven (95.7%) had anti-HBs titer <10 mIU/mL at baseline (first visit). After the first booster, 18(26.9%) had anti-HBs titer ≥10 mIU/mL. In 49 subjects who had anti-HBs <10 mIU/mL after the first dose and received another 2 booster HBV doses, 10(20.4%) still had anti-HBs <10 mIU/mL. Anti-HBs titers at baseline, after 1st booster and after 3rd booster were5.2, 8.2, and 30mIU/mL, respectively. Conclusion: In HIV-infected children who received primary series of HBV vaccine, almost all of them (95.7%) had anti-HBs lower than seroprotective level (<10 mIU/mL). Only one fourth achieved seroprotective level after the 1st booster but 79.6% achieved seroprotective level after the 3rd booster. The results suggested that HIV-infected children should receive 3 doses of HBV revaccination.