Seroprevalence and risk factors associated with leptospirosis in dogs

This study was done to determine the seroprevalence and risk factors of leptospirosis in dogs. From March to September 2004, a total of 210 dogs were randomly selected from the Small Animal Hospital, Faculty of Veterinary Medicine, Chiang Mai University. Dog sera were collected from the cephalic vein and kept at -20 degrees C until submitted to the National Institute of Health for a Microscopic Agglutination Test (MAT). Risk factors were analysed using logistic regression modelling. The prevalence of Leptospira antibodies was 11% (23/210). The most prevalent Leptospira serogroups were Bataviae 5.2% (11/210), Canicola 2.4% (5/210), Australis 1.4% (3/210), Icterohaemorrhagiae 1.4% (3/210), Ballum 0.5% (1/210), Djasiman 0.5% (1/210), Javanica 0.5% (1/ 210), Mini 0.5% (1/210), and Sejroe 0.5% (1/210). Risk factors, including signalment, environment and health status, were not significantly associated with leptospirosis antibodies. However, playing in sewage, staying outdoors >50% of the time, and consumption raw meat increased the risk of leptospirosis antibodies in dogs.     

Survival and health status of DOTS tuberculosis patients in rural Lao PDR

Background  

Contact tracing of tuberculosis (TB) patients is rarely performed in low-income countries. Our objective was to assess the outcome of and compliance with directly observed treatment (DOTS) of TB patients over a 3 year period in rural Lao PDR.     

Risk factors for epilepsy in rural Lao PDR: a case-control study

The objective of this study was to assess the major etiologic categories of epilepsy in a rural district of the Lao PDR. Thirty-one newly identified patients with confirmed active epilepsy were compared with 124 controls, matched for gender, age and village residence. Risk factors for epilepsy were investigated with particular focus on cysticercosis serology. A history of head trauma (OR=4.7, p=0.05), family history of epilepsy (OR=12.8, p=0.03), and the use of human feces to fertilize domestic vegetable gardens (OR=4.9, p=0.04) were significantly associated with epilepsy. The study did not confirm any direct relation between epilepsy and cysticercosis serology. The cysticercosis seroprevalence was nil in the epilepsy group. This is the first study in the Lao PDR on epilepsy risk factors representing important data for the subregion. Parasitic, environmental, and behavioral factors of this traditional population deserve further studies to explain the missing link between epilepsy and cysticercosis.     

Seroprevalence of human brucellosis in rural endemic areas in eastern Turkey

In this cross-sectional, community-based study, sera were obtained from 573 subjects. Brucella sero-positivity was detected in 5.4% according to the standard tube agglutination test, rising to 11.9% when the Rose-Bengal test was used. Brucellosis is a serious public health problem in eastern Turkey.     

Determinants of monthly reporting by village health volunteers in a poor rural district of Lao PDR

Village health volunteers (VHV) are community members trained as lay health workers. They are engaged in a variety of health care programs in which they are often required to make regular reports to their supervisors, including community-based surveillance data. The objective of this study was to identify factors influencing monthly reporting activities among VHV in a remote area of Lao PDR. Data were collected through structured interviews with VHV in November 2008. Logistic regression analysis was conducted to assess associations between completion of monthly reporting and socio-demographic and economic factors and VHV-related factors, such as training, experience, type of main job, and satisfaction with incentives. Of the 137 VHVs from 97 villages interviewed, 39.4% stated they submitted their monthly report at least once over the past three months. Most frequently mentioned reasons for not reporting were "no money to visit health center", "no time to visit health center", and the "health center is located too far". Logistic regression analysis showed failure to report was associated with longer distances between the VHV village and the responsible health center, lower levels of education, fewer training sessions attended by the VHV, and the type of main job of the VHV. Although most VHVs owned vehicles and were given financial support for travel, difficulty traveling to the responsible health center remains the leading cause for failure to report.     

The efficacy and physical condition of olyset insecticide-treated nets after 5 years use in rural Lao PDR

We assessed the insecticidal efficacy of Olyset nets after 5 years of use in rural villages of Lao PDR and evaluated the relationship between the physical condition of the nets and their insecticidal effect. Our results showed that most of the Olyset nets remained effective after 5 years of use; however, there was no significant relationship between the physical condition of the nets (ie, presence of holes, level of stains) and the insecticidal effect. The presence of large holes in polyester nets compared to the Olyset nets suggest the Olyset nets are stronger; however, nearly half of Olyset nets had small holes or had been previously repaired. Interestingly, the insecticide concentration and knockdown (KD) rate for 3 stored nets was low compared to the other nets routinely used in the house. To maintain the effectiveness of Olyset nets in rural villages of Lao PDR and other areas, residents should be advised to repair and store the nets appropriately and avoid exposure to high temperatures and direct sunlight for long periods.     

Reproductive health in selected villages in Lao PDR

The aim of the project was to improve the knowledge and attitude towards birth spacing by training the villagers in the selected villages of Vientiane Province in Lao PDR in family planning, providing them with the various family planning methods, and improving antenatal (ANC) and postnatal (PNC) care in the villages. Throughout the province, traditional birth attendants (TBA) were trained on several occasions during the project period. There were clear indications that reproductive health improved between 1995 and 1997. Considerable improvements were observed in the percentage of women making use of ANC and practising birth spacing by using some form of contraception or other. The most common methods used were contraceptive pills and injectables. In the case of child mortality a slight decrease was found in the percentage of women having their first pregnancy below the age of 18 years. A still unsolved problem is the high number of abortions.     

Risk mapping for Taenia solium: Applying multicriteria decision analysis in Lao PDR

Objectives

Taenia solium is ranked the most significant global foodborne parasite and the leading cause of epilepsy in low and middle-income countries. Diagnostic challenges have hampered disease control efforts to date and WHO has called for the development of risk mapping tools to assist endemic countries. This study describes the application of multicriteria decision analysis to map the risk of T. solium in Lao PDR and acts as a case study for other endemic countries.

Methods

Multicriteria decision analysis was completed using census data on relevant risk factors in Lao PDR. Factors were weighted using an analytical hierarchy process. Village risk scores were calculated using a weighted linear combination and categorised using the Fisher-Jenks algorithm into low, medium, and high risk. District risk scores and categories were calculated using the mean village risk score for a district. Sensitivity analysis was completed by doubling and halving risk factor weights, one at a time, and assessing the standard deviation of scores and categories across all scenarios.

Results

A total of 2017 (23.7%) villages were classified as high risk, with 3312 (39.0%) medium and 3170 (37.3%) low risk. This resulted in 21 (14.2%) high-risk districts, 83 (56.1%) medium and 44 (29.7%) low-risk districts. The risk maps highlight two areas of interest which are high risk and low variation. The first is the northern province of Phongsaly, which is consistent with literature and anecdotal reports. The second is the southern Salavan and Xekong provinces, which have yet to be investigated in detail.

Conclusions

Multicriteria decision analysis has provided a simple, rapid, and flexible approach to mapping the risk of T. solium in Lao PDR. The nature of the method means that it can be completed in any endemic country with available and appropriate risk factor data.     

Public and private sector treatment of malaria in Lao PDR

This study aimed to examine the care-seeking choices for treatment of a febrile illness compatible with malaria in the public and private sectors in Lao PDR. We conducted interviews with 745 heads of household in 14 villages in the Sekong province, using a structured-questionnaire. We asked each about who the care-providers were for febrile illness episodes affecting their household members during the past year. If patients used more than one care-provider for a single episode over a period of time, we identified patterns of the care-sequences for the initial and subsequent care choices. Then, we analyzed the relationship between the initial care choices and secondary care choices for care-providers by Chi-square test, categorizing care-providers into public (hospital, health centre, and village health volunteer) and private care-providers (private pharmacy, informal retailer, faith healing and herbs). As a result, we found that 624 patients sought care at least once, 255 (40.9%) twice, and 66 (10.6%) three times or more during a single episode. Of 138 patients who started with a public care-provider and then sought a secondary care, 71 (51.4%) switched to a private care-provider. In contrast, of 117 patients who started with a private care-provider and then sought a secondary care, 82 (70.1%) switched to a public care-provider (p < 0.001). In conclusion, although most patients who failed being treated by a private care-provider switched to a public one, some exclusively relied on care within the private sector. An intervention is necessary to make the private sector an integral component of malaria treatment in Lao PDR.     

Bladder stones in childhood: a descriptive study in a rural setting in Saravan Province, Lao PDR

The aim of the study was to describe clinical cases of childhood bladder stones and associated risk factors. Forty children (9 girls), aged 1-14-years old, (means 4.7 +/- 0.5 years), who underwent surgical stone removal in the Saravane Provincial Hospital during a 13-month period, were included. Bladder stone removal accounted for 55% of all surgical procedures performed on children. Most frequent symptoms were impaired micturition (97%) and acute urinary retention (32%). Body mass index was low, at < 18.5 in 92% of all cases, indicating serious associated malnutrition. Parental interviews disclosed a history of recent episodes of diarrhea (> 3 episodes in the previous year), recurrent urinary tract infection, and familial urolithiasis, in 60, 32, and 27% of patients, respectively. All children had been or were being breastfed, but 72% of the mothers introduced white rice into their children' diet as early as the first week of life, while 85% of them used to vary the food regimen (introducing meat, fish, fruit and vegetables) only after 1 year of age. This preliminary study suggests that the morbidity and social cost of childhood bladder stones may be high. A larger scale prospective and comparative study assessing their incidence and associated nutritional factors is warranted and feasible, and may lead to preventive measures.     

Pyrimethamine-sulfadoxine treatment of uncomplicated Plasmodium falciparum malaria in Lao PDR

A 28-day in vivo treatment trial to evaluate the efficacy of pyrimethamine/sulfadoxine (Fansidar, PS) was conducted in 21 Lao patients with uncomplicated Plasmodium falciparum malaria. Sixteen patients (76%) were completely cured with PS without any reappearance of asexual stage parasitemia during the follow-up examination. On the other hand, 5 patients (24%) failed to respond to this trial medication, resulting in recrudescence of asexual stage P. falciparum malaria. PS resistance resulted in higher prevalence of post-treatment gametocytemia, 25% gametocyte carriers among PS sensitive cases versus 75% of the resistant cases. These findings suggest that although the level of PS resistance is still valid for treatment of malaria in the study area of Lao PDR, post-treatment induction of gametocytemia among resistant cases may result an increase in transmission rate of PS resistant falciparum malaria.     

Control of intestinal parasitic infection--a pilot project in Lao PDR

Intestinal helminths are a very common but still rather unrecognized public health problem. An attempt was undertaken to control the three important parasites, ie Ascaris, Trichuris and hookworm. Two villages in Vientiane Province in Lao PDR were selected, one as an intervention and the other as control village. Intervention measures started by providing mass treatment against Ascaris, Trichuris, hookworm and other intestinal parasitic infections in both villages. Health education and other intervention measures were implemented in the intervention village, which significantly influenced the re-infection rates in this village. These achievements were not due to an improvement of the availability of toilets or personal hygiene alone but more to the villagers' improved understanding of the route of the parasitic infections. It was concluded that intervention methods should be directed more towards particular age groups. Particular attention should be paid to control parasitic infections among females.     

Preliminary studies of Anopheles mosquitos in eight provinces in Lao PDR

Malaria vector surveys were carried out in 8 provinces in Lao PDR in 1999. The surveys were conducted in 4 provinces - Savannakhet, Champasak, Luang Perbang and Sayaboury in May and in another 4 provinces - Bolikhamsay, Sarvan, Sekong and Vientiane in December 1999. Bare leg collection were carried out indoors and outdoors from 6 pm to 5 am. All anopheline mosquitos were identified, dissected and the gut, gland and ovaries were examined. A total of 438 Anopheles mosquitos belonging to 19 species were obtained. Of these only 3 species were found to be infected with oocysts - An. maculatus, An. dirus and An. minimus. All these species were found biting both indoors and outdoors. An. aconitus was the predominant species obtained in the December collection but its vectorial status remains unknown.     

Plasmodium ovale infections detected by PCR assay in Lao PDR

Plasmodium ovate infection was demonstrated in 5 out of 143 inhabitants in a village in Lao PDR by blood microscopy and PCR assay. Although the specimen confirmed to be positive for P. ovale by microscopical examination was only one, the target sequences in the 18S rRNA genes of malaria parasite detected in all of the five cases were consisted with those of P. ovale by the PCR assay. This is the first report concerning the presence of so many cases with P. ovale infection in Lao PDR.     

Endemic malaria in four villages in Attapeu Province, Lao PDR

A study was conducted in four villages in Attapeu Province, Lao PDR in 2002 to determine malaria endemicity. The study villages were Mixay, Beng Phoukham, Phou Vong and Pier Geo. Mass blood surveys were conducted in May, August, and October. Finger prick blood was collected for thick and thin blood film as well as for dipstick. The slide positivity rate was highest in Phou Hom in October (41.7%). Plasmodium falciparum was the dominant species comprising more than 80% of the cases. As a whole, the distribution of malaria was similar among males and females. Children below 15 years accounted for a large percentage of the cases. The sensitivity of the optimal dipstick was 62.36 and the specificity was 61.7. Microscopy was taken as the gold standard. Anopheles dirus was found to be the main vector and the vectorial capacity correlated well with the cases.     

An ecological survey of dengue vector mosquitos in central Lao PDR

An ecological survey of dengue vector mosquitos was carried out in June 2000 in central Lao PDR. Two areas in Khammouane Province, Nongbok and Thakhek, were selected for the survey. Of the 7 mosquito species identified, Aedes aegypti was dominant in both study areas. The container index for Ae. aegypti in Nongbok was 51.8% and was significantly higher than that of Thakhek (40.2%); moreover, significant differences between the study areas were found with records to containers and to the conditions surrounding the houses. The key containers in Nongbok were water jars, whereas drums or small or discarded containers had the highest occurrence rate of Ae. aegypti in Thakhek. Mesocyclops aspericornis was found in large water jars and cement water tanks; no Aedes larvae were found at these sites. Strategy to control dengue vectors in the study areas was discussed.     

Decentralization and recentralization: effects on the health systems in Lao PDR

In Lao PDR, lack of skilled manpower and financial resources in the central government, plus the policy urging local authorities to be self-sufficient and self-reliant caused the central government to decentralize all sectors to the provincial level in 1987. After 1987, the provinces took over all responsibilities such as planning, financing and provision of health services, only informing the Ministry of Health (MOH) about their activities. Because of economic differences between the 18 provinces, health services became unequal between the richer and poorer provinces. Some provinces generated high revenues, leading to over spending. The decentralized system had some negative impacts on the health service. The technical and planning functions managed from the ministry level became separated from management and financial decision making at the local level, and the ministry lost influence on the direction of health policy. Salaries from the local government were often delayed. Because health budgets were not allocated centrally by the Ministry of Health, there were no mechanisms by which health resources could be distributed preferentially to poorer areas with greater need. However, donors continued to support health programs through the Ministry of Health, sending drugs, vaccines, and other supplies to the provinces. The implementation of decentralization faced many difficulties due to the lack of experienced staff and insufficient training required for practicing decentralization. Similar problems in other sectors, such as agriculture, education, and communication, caused the central government to retake control from the provinces in 1992. During the recentralization period, utilization of health facilities increased. The Ministry of Health set rules and established regulations to strengthen the health system. A cost-recovery system was introduced to obtain additional funds, and conditions in the provinces gradually improved. The unique situation of decentralization followed by recentralization provides an excellent opportunity for study. We reviewed documents relating to these periods and interviewed officials at all levels who were concerned with the process.     

Malaria transmission by Anopheles dirus in Attapeu Province, Lao PDR

A study was carried out in four malaria-endemic villages in Attapeu Province, in the southern region of Lao PDR. All-night human landing collections were carried out in May, August, and October 2002, to determine malaria vectors. At the same time, mass blood surveys were also carried out in the same villages. Anopheles dirus was the predominant species in three of the study villages. Sporozoites were found only in An. drius from Phou Hom. However, in Beng Phoukham, An. dirus was positive for oocysts. The distribution of malaria cases was highest in Phou Hom and this correlated well with the vectorial capacity of An. dirus. The risk for infection from An. dirus was also high, at 0.99.     

Seroprevalence of tularemia in rural Azerbaijan

A representative, two-stage probability sampling design was used to select 40 villages in northern Azerbaijan with populations of <500 people to screen for evidence of prior infection with Francisella tularensis. Informed consent was provided, and samples were obtained from 796 volunteers and tested for the presence of immunoglobulin G antibodies using enzyme-linked immunosorbent assay. F. tularensis seropositivity was prevalent (15.5% of volunteers), but there was minimal reporting of signs and symptoms consistent with clinical tularemia, suggesting that mild or asymptomatic infection commonly occurs. Frequently seeing rodents around the home was a risk factor for seropositivity (POR?=?1.6, p?=?0.03), controlling for age and gender. Geospatial analysis identified associations between village-level tularemia prevalence and suitable tick habitats, annual rainfall, precipitation in the driest quarter, and altitude. This study contributes to the growing understanding of the geographic distribution of tularemia and provides further information on the climatic and landscape conditions that increased the potential for exposure to this pathogen. The potential occurrence of asymptomatic or mild F. tularensis infection warrants further study.