Rationale and Background: : Gender-based violence (GBV), especially domestic violence, is prevalent in Lao PDR. Yet, it is largely a ‘hidden’ and unaddressed problem. Engaging men and boys in GBV prevention first requires an understanding of how men and boys’ perceptions of gender norms and GB. This study is aimed to explore gender and masculinity and men’s level of awareness of GBV, and attitudes towards GBV in Lao PDR and to identify factors associated with men’s awareness of GBV and attitudes towards GBV in Lao PDR. Methodology: : A quantitative research method community-based study was conducted among married men in Vientiane and Champasak provinces, Lao PDR. The sample was married or cohabiting males in a heterosexual union living in the community for at least 1 year. The sample size for the quantitative survey was 680 men and a multi-stage random sampling scheme was applied. Descriptive and Inferential statistics were applied. A bivariate logistic regression model followed by multivariable analysis was performed to identify the associated factors of GBV. Results: : About 44.6% of men in particular suffered more severe forms of physical violence. Overall, 43.2% of male participants had positive attitudes towards gender equality and 67.1% of male participants had positive attitudes towards GBV. Overall, 99.4% of male participants ever reported physical violence during their lifetime Gender Equality Matters while 76% reported having physical violence during the last year. About one-fourth of participants (20.3%) had sexual violence during the last year. The majority of participants (84%) had good knowledge of GBV, but 46.7% had high knowledge of different types of GBV. Persons living with their family (AOR: 2.9; 95% CI: 01.1-7.2); attitudes towards GBV (AOR: 5.4; 95% CI: 3.7-9.6); men’s awareness of the effectiveness of strategies to engage men in GBV prevention (AOR: 12.2; 95% CI: 4.7-31.7) were significantly correlated with knowledge of GBV. While factors statistically significant associated with positive attitudes towards GBV were non-Lao-Tai ethnic (AOR: 0.2; 95% CI: 0.1-0.4); knowledge of GBV (AOR: 4.9; 95% CI: 3.1-7.9); and men’s awareness on the effectiveness of strategies to engage men in GBV prevention (AOR: 0.2; 95% CI: 0.1-0.3). Conclusion: This study highlights the good knowledge of GBV among male participants and the low knowledge of different types of GBV. It also revealed the positive attitudes towards GBV and high Gender Equality Matters (GEM). Factors statistically significant associated with knowledge of and attitudes towards GBV among male participants were socio-demographic characteristics, attitudes towards GBV, and men’s awareness of the effectiveness of strategies to engage men in GBV prevention. Men-oriented programs, such as those involving men, also address gender norms, with promising results including increased equitable attitudes and reduced self-reported gender-based violence perpetration.

Background: : According to the World Health Organisation, Lao PDR was among the top 10 countries with the highest reduction in maternal mortality between 2000 and 2020. However, maternal mortality rates remain high compared to most countries in the WHO Western Pacific Region, with an estimated 126 deaths per 100,000 live births in 2020. The major non-obstetric causes of maternal mortality were HIV and tuberculosis (TB) infections. Objectives: : To determine the proportion of HIV/TB testing and assess knowledge of HIV and TB among pregnant women attending antenatal care (ANC) at the Central hospitals, Vientiane provincial hospitals, and peri-urban district hospitals in Vientiane Capital. Methodology: : This cross-sectional study was conducted from July 2022 to December 2022. Four central hospitals and four district hospitals in Vientiane City and Vientiane Provincial Hospital were selected as study sites. Participants were interviewed face-to-face using a standardized questionnaire covering sociodemographic characteristics, obstetric history, ANC attendance, HIV/TB testing history, and knowledge of and attitudes towards HIV/AIDS and TB. Data were analyzed using STATA version 17. Univariate analysis, including frequencies and percentages, was used to describe variables and identify patterns. Factors associated with adequate knowledge of, and attitudes towards HIV and TB were assessed using multiple logistic regression analysis. Results: : Among 1,964 pregnant women attending ANC at the selected sites, the proportion of HIV-positive cases detected via rapid testing was 0.6%. None of the participants had been tested for TB. Misconceptions about HIV and TB were prevalent. For example, 35.7% of participants believed that HIV could be transmitted by sharing food with an infected person, and only 13.7% correctly identified TB as being caused by bacteria. Overall, 45.0% and 42.8% of participants had good knowledge of HIV and TB, respectively. Additionally, 25.9% pregnant women had a positive attitude towards HIV/AIDS, while 45.1% had a positive attitude towards TB. Factors significantly associated with knowledge of HIV/AIDS and TB included obstetric and ANC history, positive attitudes towards TB, and awareness of TB testing locations. Conclusion: The study highlighted a low prevalence of HIV/AIDS among pregnant women attending ANC at central and district hospitals in Vientiane Capital. However, knowledge of HIV/TB was limited, and attitudes towards HIV/TB were generally negative. These findings emphasize the need for targeted interventions, educational initiatives, and awareness campaigns to improve knowledge, correct misconceptions, and foster positive attitudes towards HIV/AIDS and TB among pregnant women. The insights from this study can inform the development of policies, programs, and preventive strategies aimed at reducing HIV/AIDS and TB infections.

Rationale and Background: : The COVID-19 pandemic posed a significant global public health challenge, affecting health care access and provision across all age groups. With limited literature available on its impact in Lao PDR. Objectives: : to investigate individuals’ confidence of in accessing health care services before, during, and after the pandemic. Methodology: : A cross-sectional study was conducted in three provinces (Vientiane, Luangprabang and Champasak) using a multi-stage household sampling approach. A total 2,300 participants were recruited, including youth (15-24 years old), adults (25–59 years old) and elderly people (60–75 years old). Data were collected through face-to-face structured interviews, covering health care access before, during and after the pandemic, together with characteristics of individual, household, community and policy-related factors. Descriptive and multiple logistic regression analyses were performed to determine factors associated with confidence to access health services among individuals. Results: : The study recruited 545 youths, 1,370 adults and 385 elderly people (female 51.7%, 54.2% and 55.1% respectively). Nearly half of participants had poor COVID literacy (48.4%). Nearly three-quarters (71.3%) had a high level of depression-anxiety-stress scale (DASS) related to COVID. More than one-third of participants (36.7%) had a reduction of confidence to access health care (youth: 36.3%, adult: 36.4% and elders: 38.2%). Factors associated with reduced confidence varied across age groups and levels. Key influencing factors included high COVID-related DASS scores, difficulties in seeking care, insufficient information, lack of a supportive person or community, and having a family member with a chronic-illness. Conclusion: To maintain confidence in healthcare access, adequate information dissemination must be prioritized, particularly in communities with limited accessibility and households with ill members. Future research should focus on health system preparedness and community engagement in response to future public health emergencies.

Introduction: : Adolescent sexual and reproductive health (SRH) remains a major public health concern. Effective parent-child sexual and reproductive health communication (PCSC) has been shown to reduce the incidence of unintended pregnancies, sexually transmitted infections (STIs), including human immunodeficiency virus (HIV), and to delay the onset of adolescent marriage and pregnancy Objectives: : This study aimed to explore the perceptions, attitudes and practices related to PCSC among parents and adolescents in Bolikhaxay province, Lao People’s Democratic Republic (Lao PDR). Methodology: : A cross-sectional quantitative study was conducted involving 496 participants, comprising adolescents aged 15–19 years and their parents, from two randomly selected urban and peri-urban communities in Bolikhamxay province, Lao PDR. Socioeconomic data were collected, and structured face-to-face interviews were conducted to assess engagement in, understanding of, and attitudes towards PCSC. Descriptive statistics and multivariate logistic regression analyses were performed to identify factors associated with engagement in PCSC. Results: : Only 32.9% of parents reported engaging in PCSC in two or more SRH topics at least twice within the six-month study period. Factors significantly associated with increased PCSC included higher monthly household income (adjusted odds ratio [AOR] = 0.50; 95% confidence interval [CI]: 0.33- 0.76), a positive parental attitude toward SRH communication (AOR = 2.74; 95% CI: 1.80- 4.18), and greater parental self-efficacy regarding SRH communication (AOR = 5.06; 95% CI: 3.31,-7.74). Conclusion: Engagement in PCSC was suboptimal among families in Bolikhamxay province. Parental self-efficacy and positive attitudes toward SRH communication were positively associated with increased engagement, while lower household income was inversely associated. Targeted interventions to enhance parental SRH knowledge and communication confidence are warranted. Community based campaigns and digital platforms may serve as effective tools to promote open and informed SRH discussions among parents, teachers, local authorities, health professionals, and adolescents.

Rationale and Background:: To develop more effective intervention strategies against dengue, it is essential to estimate the impact of higher temperatures on dengue prevalence, and risk factors associated with infection. Objectives: : To assess the prevalence of dengue fever in Vientiane Capital, Lao PDR and gain insights into environmental and sociodemographic factors associated with infection. Methodology: : An observational quantitative research design was used, comprising 1) a cross-sectional household survey conducted in selected districts in Vientiane Capital (Xaysetha, Sikhottabong, Hadxaifong, Xaythany) using structure interview questionnaires that covered socio-demographic characteristics, knowledge about dengue fever and information relating to the household environment and 2) a review of data regarding the temperature and temperature in Vientiane Regency from 2007–2022. Data analysis was conducted using STATA. Results: : A total of 954 participants (94% of expected samples) were included in the study. Gender and age were not significantly associated with dengue fever infection rates (p=0.781 and p=0.607, respectively). However, occupation, ethnicity, and limited living space were significantly associated with higher odds of having dengue fever (OR=0.60, p=0.003), (OR=6.28, p=0.035; and OR=0.43, p=0.001, respectively). Economic factors such as income and perceived economic status showed no significant correlation with dengue fever infection. Additionally, minimum and average temperature fluctuations increased annually, with significant associations with dengue prevalence (p<0.001 and p=0.024). Conclusion: Dengue fever prevalence remains high and fluctuates annually, with a peak during the rainy season. Warmer temperatures appear to contribute to increased dengue infections. Dengue prevention efforts continue to face challenges, emphasizing the need for enhanced preventative measures, particularly during the rainy season. Furthermore, these findings highlight the importance of continued research on temperature-dengue relationships, particularly in the context of global climate change, to support adaptive disease surveillance and control strategies.

Background and rationale: : Diarrhea is the leading cause of death in children under five years of age. Most deaths are due to dehydration and inadequate management. The knowledge of caregivers in managing diarrhea tends to be related to outcomes. However, these issues can be addressed through the management and treatment of diarrhea in children to prevent dehydration by providing adequate fluids from the start, continuing to feed, and providing oral rehydration solutions. Objective: : To determine the prevalence of diarrhea, describe care-seeking behaviors, and determine the proportion of appropriate health-seeking behaviors for diarrhea and the level of caregiver knowledge about diarrhea in children aged 6-59 months. Methodology: : This study was a cross-sectional study was conducted with 445 mothers/caregivers of children who had experienced childhood diarrhea in Kaysone, Oudomphon, Atsaphangthong, and Sungkhone districts of Savannakhet province using a quantitative questionnaire. Qualitative studies were also conducted with 10 FGDs, one in each village FGD and each village consisted of 6 participants. A research assistant will do this with the lead researcher who will observe the participants’ responses. Results: : This study found that 1/3 of caregivers also had poor health-seeking behavior. The results showed that factors associated with health-seeking behavior were female gender (AOR=0.56; p=0.05), high knowledge (AOR=0.20; p=0.001), positive attitude towards diarrhea (AOR=0.36; p<0.001) and no service fee, insurance (AOR=3.69; p<0.001). Conclusion: The study recommends that the Ministry of Health create a program to help address diarrhea in children under 5 years of age to help educate mothers about identifying signs and symptoms, causes, prevention measures, and management of diarrhea.

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.

Background and rationale: : Human immunodeficiency virus (HIV) is a major public health problem in all countries around the world, having claimed 36,3 million lives so far. Lao PDR. HIV has been increasing among key populations, particularly men who have sex with men (MSM). According to the 2017 Integrated Biological and Behavioral Surveillance (IBBS), the prevalence rate of HIV among MSM in Vientiane Capital has increased from 2.8% in 2014 to 7% in 2017. Objective: : This study aimed to identify the factors associated with HIV infection among men who have sex with men in Vientiane capital of Lao PDR. Methodology: : This study was a matched cases-controls study in a sample of 192 men who have sex with men registered with a positive HIV test result (Case) in Mahosot Hospital, Setthathirat Hospital, and Mittaphab Hospital and those with a negative HIV test result (Control) in Vientiane Capital. With a 1:1 ratio of 96 cases and 96 controls, with matched sexual roles (intimate or penetration, receptive, both intimate and receptive) using a purposive sampling method. Data collection was done using a face-to-face interview form with informed consent from the interviewees. All data were entered into the Epi-data program and transferred to the STATA program for data analysis. Results: : Out of 192 participants, the mean age for all participants is 27.2(+5.7) years; 69.8% of cases and 59.4% of controls are in the age group of ≥ 25 years old. The marital status for both groups most 94.8% were single. 45.9% of cases and 69.8% of controls had the higher education or equivalent to the diploma level. Cases were more likely than controls to have had a monthly income of >1,600,000 (56.2% vs. 40.6 %). Factors associated with HIV infection were monthly income of >1,600,000 (AOR=2.4; 95%CI=1.0-5.0; P-value=0.040), low knowledge of HIV (AOR=4.8; 95%CI= 1.9-11.9; P-value=0.001), bisexual (AOR=4.6; 95%CI= 1.2-17.1; P-value= 0.019), not always using condoms with male casual partners (AOR=14.7; 95%CI= 5.3-40.8; P-value<0.001), ever sexual behavior stigma (AOR=3.1; 95%CI= 1.2-8.1; P-value=0.015) and not interested PrEP (AOR=10.5; 95%CI= 4.1-26.8; P-value<0.001). Conclusion: The findings of the factors associated with HIV infection, which including of monthly income, knowledge of HIV, sexual preference, condom used, feeling of stigma regarding to sexual behavior, and access to PrEP. This study will provide the information for action plans and the development HIV prevention activities among MSM. There should be promoting condom used, accessing to PrEP, and HIV prevention information in order to reduce the new HIV infection cases.

Background: The prevalence of Autoimmune Hemolytic Anemia (AIHA) globally ranges from 5-30%, but relatively high in Asia, 22%. This condition is commonly found among patients with thalassemia. However, no data are available about this disease in Lao PDR. Objective: To determine the proportion of AIHA among Lao children with thalassemia. Methodology: A cross-sectional study was conducted from May to September 2018 in pediatric patients with thalassemia who received blood transfusion at the Children’s Hospital, Vientiane Capital. There were 338 patients included in the study. Data analysis was done using SPSS, and Pearson chi-square was used to compare the two proportions. Finding: We found that the proportion of AIHA was 3.6% (12/336) amongst those with thalassemia with more males than females (3:1). The mean (SD) age was 11.5 ± 3 years old. The older age of patients was significantly associated with AIHA, p=0.001. We also found that patients with transfusion dependent thalassemia were more likely to have AIHA than those who were not. The mean reticulocyte count (%) was significantly higher in patients with AIHA than those without AIHA (8.61±10.57 versus 1.18±1.14, p<0.001). Other variables such as sex, type of thalassemia, age at diagnosis, the frequency of blood transfusion, age at first blood transfusion, blood group and hemoglobin before blood transfusion were not significantly associated with AIHA. Conclusion The proportion of AIHA remains low in Lao children with transfusion dependent thalassemia, but requires further attention to reduce its complications. There is a need to identify factors associated with AIHA among Lao patients with Transfusion Dependent Thalassemia

Background: Hypertension in children is one of major concerns in public health. However, there is no evidence within the Lao population. Therefore, we aimed to determine the prevalence of hypertension in children and adolescents aged 11-15 years old. Methodology: A descriptive, cross-sectional study was conducted in children and adolescents aged 11-15 years old at secondary schools of Vientiane Capital, Lao PDR. Two secondary schools were purposively selected, Vientiane and Bornagnao schools. The data were collected using questionnaire form. Result: A total of 365 students were included in the study of which 50.7% were male. The mean age was 13.7 years old (Min=11 and Max=15). The majority of students were of Lao Loum ethnicity (95.1%). Of 365 students, 140 (38.3%) had high blood pressure during the survey. Of these, 99 (27.1%) people were at pre-hypertension, 6.3% in stage 1 and 4.9% in stage 2. Most (74.5%) of included students had normal Body Mass Index (BMI). Students with overweight and obesity were significantly more likely to have hypertension than others (p<0.001). Conclusion We found a high prevalence of hypertension in secondary school students particularly in those overweight and obese. Therefore, it is important to provide appropriate education at school to reduce the risk factors as well as hypertensive screening.