Dengue is a public health issue in tropical south-eastern Asia responsible for significant morbidity and mortality. Information on dengue epidemiology is necessary for developing strategies to control infections effectively. In the Lao People’s Democratic Republic (Lao PDR), Champasak and Savannakhet provinces account for around 30% of the national dengue burden. In this study, the dengue epidemiological profile in these two southern provinces of Lao PDR was described by analysing seasonal and spatial dengue notification data from 2003–2020 using the long-term mean (LTM) method. Savannakhet had a higher LTM (132.0 cases/month, 95% confidence interval [Cl]: 92.2–171.7) than Champasak (113.3 cases/month, 95% CI: 86.0–140.5), with peaks in dengue notifications following the rainy season in both provinces. The highest notification rates were observed in July to September; these months were also when the LTM was most frequently exceeded. Previously, dengue notifications were largely confined to the western districts of Savannakhet and the northern districts of Champasak, but more recently, notifications have increased in the eastern districts of Savannakhet and southern districts of Champasak. While the notification rate remained high in children and young adults (5–30 years), especially among students and farmers, a shift in the age structure of dengue cases was observed, with a greater proportion of notifications now occurring in those aged over 30 years. Community-based vector control and prevention programmes are needed to restrict the spread of dengue into new geographical areas in the southern provinces of Lao PDR.

Background: Congenital heart disease is the most common causes of major congenital malformations. Congenital heart disease (CHD) represents, globally, 28% of all congenital anomalies, with a prevalence of about 8 to 10 per 1000 people live births, and they mostly require corrective surgery. Objective: To describe outcomes of congenital heart surgery in children under 15 years in Vientiane, Lao PDR. Methods: We undertook retrospective analyses of children with CHD who underwent cardiac surgery by the ASD teams at the Laos-Luxembourg Heart Center, Mahosot Hospital, Vientiane Capital, by reviewing the medical charts of patients discharged during 1st January 2014 to 31st December 2018. Results: Of a total of 415 patients with CHD, 185 underwent cardiac surgery that were the simple lesion 62.1%; moderate lesion 36.0%, complex lesion 1.6%, respectively. The patients who met the inclusion criteria in this study were 158 with a median age of 51 months and those with preschool age of 52.0%. Corrective surgery was the commonest conducted at 98.1%. The major procedure was VSD closure at 34.8%. The post-operative complication found in 30.0%. Overall in hospital mortality rate was 8.8% (by RICHS-1 method). Conclusion Congenital heart disease surgery in children under 15 years old at Laos-Luxembourg Heart Center, Mahosot Hospital was significantly associated with post-operative complications and high mortality. Therefore, trainings on CHD surgery and Post-CHD surgery care must be urgently organized to the Lao cardiac surgeons and nurses to reduce complications and deaths.

Background and rationale: Infections caused by bacteria are significant public health problems and the roots of much illness and death in Laos. Hemoculture is the gold standard for the diagnosis of septicemia and the aetiological agents. However, the result of blood culture depend on many factors, from the collection of blood by nurses until completing and reporting the laboratory analysis. The process of blood collection by nurses plays an important role for optimizing culture yields in the laboratory and the result will be more accurate with a lower contamination rate, if performed using strict sterilized techniques. Correct blood collection and culture practices will also reduce the risks of needle-stick injuries and harm. Objective: To study behavior on blood collection from patients by nurses for culture at Microbiology Laboratory of Mahosot Hospital, Vientiane Capital. Methodology: The study was descriptive, cross-sectional quantitative study to the nurses who were performing blood collection for culture and who answered questionnaires. The reported behavior of the nurses was also compared to that observed by the researcher. Data entered into the Excel and analyzed with STATA. Results: The majority of the study nurses were female (92%) with a mean age of 33 years, a mid-level of nursing study (82.4%), and with an average duration of working of 7 years. The awareness of nurses about the importance of blood collection technique for culture was in the range from 43.3% and 30.0% rating as high and intermediate respectively. Right attitude towards accurate practices was 27.0%. The reported correct practice of blood collection by the nurses was 38% however the correspondent figure by observation was only 12%. Older age, longer work experience, better work knowledge, attitude were significantly associated with correct blood collection procedures (P-value <0.05). Conclusion The techniques and knowledge of the nurses for collecting blood cultures remains low due to lack of knowledge, techniques, procedures and methods to collect and deliver samples. Therefore, adequate and regular trainings are urgently needed.

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.

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.

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.

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.

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.

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

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.