Relationship of intestinal parasites to the environment and to behavioral factors in children in the Bolikhamxay Province of Lao PDR

From March to July 1998 the infection rates of 732 children aged below 15 years were assessed. The investigation was conducted in selected villages of the Bolikhamxai Province in Lao PDR. Socio-economic conditions and behavioral pattern were studied. The three soil-transmitted helminths, Ascaris lumbricoides, Trichuris trichiura and hookworm were found with prevalence rates of 67.14, 17.49 and 12.83%, respectively. Infection rates with other intestinal parasites were negligible. Of the children investigated, 56.7% harbored one and 20.45% more than one parasite. Except for hookworms, no statistically significant differences were found between genders. The probability of being infected with A. lumbricoides is associated with living in mountainous areas. For hookworms, infection is associated with staying in the plains. A river in the vicinity of the village is linked with the probability of being infested with Trichuris trichiura. Not to belong to a family with the ability to own expensive items increases the probability by almost two times of getting infested with A. lumbricoides. Unhygienic behavioral factors were important in increasing the probability of suffering from A. lumbricoides and T trichiura infection. Behavioral factors did not seem to be related to hookworm infections. It was concluded that after mass treatment, besides promoting the construction of toilets, it is also important to improve personal hygiene so that a lasting impact on the infection rate of the most prevalent parasites in Lao PDR could be achieved. Measures to control parasitic infections do not have to be postponed until a marked improvement of the economic situation has occurred.     

Advantages of trained TBA and the perception of females and their experiences with reproductive health in two districts of the Luangprabang Province, Lao PDR

The study describes reproductive health in two districts of the Luangprabang Province in northern Lao PDR. The aim was to find out whether training traditional birth attendants (TBA) might have an impact on reproductive health. In June/July 2000, a total of 298 women of reproductive age, with children below two years of age, from 30 villages were interviewed by means of a closed questionnaire. In 1996/1997, a training course for TBA was conducted in one of the districts under survey. Information was obtained for demography, symptoms and risks during pregnancy and delivery, antenatal care (ANC), tetanus immunization, food taboos, place of delivery, birth attendant, practising of birth spacing and their attitude towards the services of TBA. The results obtained indirectly pointed towards a high fertility rate and a high rate of child death and abortion. An overwhelming majority of the women delivered at home, attended only by untrained individuals. During pregnancy and after delivery, the women claimed that they often suffered from edema of legs and feet, high fever and hemorrhages. Only 50% of the females in the district where TBA training were conducted, made use of the services of trained TBA. Nevertheless, females in the district with trained TBA, who made use of the TBA service in comparison with women in the same district not using the service of TBA, were 3.8 times more likely to also make use of the ANC service; 3.3 times more likely to seek immunization, and 8.6 times more likely to give colostrum to their new-borns. The educational level of the females proved to be an important factor. Literate women were more likely to practise birth spacing and have been vaccinated. Illiterate women were more likely to be at higher risk for losing a child. In the district without TBA service the loss of a child was less likely among literate than illiterate women. It is concluded that through adequately trained TBA and through their continuous support and supervision, ANC and health education can be improved. In addition to the improvement of the referral system for emergency cases and manpower development within the obstetric curative service, the training of TBA will have a positive impact on reproductive health. However, maternal health depends, to a large extent, on the educational level of the women.     

A cross-sectional community study of post-traumatic stress disorder and social support in Lao People's Democratic Republic

Objective

To estimate post-traumatic stress disorder (PTSD) symptoms in those injured and not injured by landmines or unexploded ordnance (UXO) in rural Lao People''s Democratic Republic and to determine whether the perception of social support was associated with PTSD symptom severity.

Methods

A community survey was conducted among 190 people injured by landmines or UXO and 380 age-, sex- and neighbourhood-matched non-injured individuals in the Sepone district of Savannakhet Province, the part of the Lao People''s Democratic Republic most heavily bombed during the Viet Nam War. Using the Harvard Trauma Questionnaire and the Medical Outcomes Study Social Support Survey, trained health-care workers conducted face-to-face interviews to assess PTSD symptoms and level of perceived social support. Multiple linear regression was performed to explore the association between social support and other factors and PTSD.

Findings

The prevalence of PTSD was higher among the injured (10%) than among the non-injured (4%), but the level of perceived social support was not significantly different between the two groups. A higher level of perceived social support was associated with milder symptoms of PTSD. Women, older people and those with a formal education were more often and more severely affected by PTSD.

Conclusion

The perception of strong social support might help to alleviate the symptoms of PTSD among people injured by landmines or UXO in rural parts of the Lao People''s Democratic Republic. Psychosocial interventions should be incorporated in assistance for the injured because they have more severe and longer-lasting symptoms of PTSD than the non-injured.