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The determinants of vaccination in a semi-rural area of Vientiane City, Lao People's Democratic Republic: a qualitative study.

ABSTRACT: BACKGROUND:Immunisation is a cost-effective and highly efficacious public health intervention, saving over 20 million lives in the last two decades due to decreases in childhood bacterial infections. In the Lao People's Democratic Republic, significant gaps in childhood immunisation coverage rates remain, which are a cause for concern and a barrier to the country reaching its Sustainable Development Goal targets for child health. Efforts to increase coverage have had limited success, with widening inequities being observed between urban and remote and rural areas. METHODS:The objectives of this study were two-fold; firstly, to describe the knowledge, attitudes and practices of mothers regarding their children's immunisation status; and, secondly, to identify individual and health system determinants of access to immunisation in five rural villages within a rural district in Lao People's Democratic Republic. This qualitative research used observation and interviews with healthcare workers (n?=?10) and mothers (n =?10) with at least one child aged 12-23?months. RESULTS:The study identified several health system barriers that lower community demand for immunisation. These included the use of multiple providers, inconsistent record keeping and an inadequate health information system. At the individual and household level, there was a lack of understanding of the role of immunisation and the role of the different services provided. CONCLUSIONS:The study suggests that increasing immunisation coverage in Lao People's Democratic Republic requires clearer immunisation pathways, an integrated or unified information recording system across the different levels of the health system, and strategies to increase demand, including increasing individual and household understanding of the role of immunisation in child health.

SUBMITTER: Sychareun V

PROVIDER: S-EPMC6325875 | biostudies-other | 2019 Jan

REPOSITORIES: biostudies-other

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The determinants of vaccination in a semi-rural area of Vientiane City, Lao People's Democratic Republic: a qualitative study.

Sychareun Vanphanom V Rowlands Lucy L Vilay Phoutsomphong P Durham Jo J Morgan Alison A

Health research policy and systems 20190109 1

<h4>Background</h4>Immunisation is a cost-effective and highly efficacious public health intervention, saving over 20 million lives in the last two decades due to decreases in childhood bacterial infections. In the Lao People's Democratic Republic, significant gaps in childhood immunisation coverage rates remain, which are a cause for concern and a barrier to the country reaching its Sustainable Development Goal targets for child health. Efforts to increase coverage have had limited success, wit ...[more]

PMID: 30626379

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Project description:BackgroundDiphtheria is a vaccine-preventable disease. When vaccination coverage and population immunity are low, outbreaks can occur. We investigated a diphtheria outbreak in Lao People's Democratic Republic that occurred during 2012-2013 and highlighted challenges in immunization services delivery to children in the country.MethodsWe reviewed diphtheria surveillance data from April 1, 2012-May 31, 2013. A diphtheria case was defined as a respiratory illness consisting of pharyngitis, tonsillitis, or laryngitis, and an adherent tonsillar or nasopharyngeal pseudomembrane. To identify potential risk factors for diphtheria, we conducted a retrospective case-control study with two aged-matched neighborhood controls per case-patient in Houaphan Province, using bivariate analysis to calculate matched odds ratio (mOR) with 95% confidence intervals (CI). Reasons for non-vaccination among unvaccinated persons were assessed.ResultsSixty-two clinical cases of diphtheria and 12 diphtheria-related deaths were reported in seven of 17 provinces. Among case-patients, 43 (69%) were <15years old, five (8%) reported receiving three DTP doses (DTP3), 21 (34%) had received no DTP doses, and 35 (56%) had unknown vaccination status. For the case-control study, 42 of 52 diphtheria case-patients from Houaphan province and 79 matched-controls were enrolled. Five (12%) case-patients and 20 (25%) controls had received DTP3 (mOR=0.4, CI=0.1-1.7). No diphtheria toxoid-containing vaccine was received by 20 (48%) case-patients and 38 (46%) controls. Among case-patients and controls with no DTP dose, 43% of case-patients and 40% of controls lacked access to routine immunization services.ConclusionSuboptimal DTP3 coverage likely caused the outbreak. To prevent continued outbreaks, access to routine immunization services should be strengthened, outreach visits need to be increased, and missed opportunities need to be minimized. In the short term, to rapidly increase population immunity, three rounds of DTP immunization campaign should be completed, targeting children aged 0-14years in affected provinces.

Project description:BACKGROUND: HIV infection is an emerging problem in Laos. We conducted the first prospective study on intestinal parasites, including opportunistic protozoa, in newly diagnosed HIV infected patients, with or without diarrhea. The aims were to describe the spectrum of infections, to determine their prevalence and to assess their associations with diarrhea, CD4 cell count, place of residence and living conditions. METHODOLOGY: One to three stool samples over consecutive days were obtained from 137 patients. The Kato thick smear method, formalin-ethyl concentration and specific stains for coccidia and microsporidia diagnosis were performed on 260 stool samples. Baseline characteristics regarding relevant demographics, place of residence and living conditions, clinical features including diarrhea, were collected using a standardized questionnaire. PRINCIPAL FINDINGS: The 137 patients were young (median age: 36 years) and severely immunocompromised (83.9% at WHO stage 3 or 4, median CD4 cell count: 41/mm3). Diarrhea was present in 43.0% of patients. Parasite infection was found in 78.8% of patients, infection with at least two species in 49.6%. Prevalence rates of protozoan and helminth infections were similar (54.7% and 58.4% respectively). Blastocystis sp. was the most frequent protozoa (26.3%). Cryptosporidium sp., Cytoisospora belli and microsporidia, found at low prevalence rates (6.6%, 4.4%, 2.9%, respectively), were described for the first time in Laos. Cryptosporidium sp. was associated with persistent diarrhea. Strongyloides stercoralis was the most prevalent helminth following Opisthorchis viverrini (20.4% and 47.5% respectively). The most immunocompromised patients, as assessed by a CD4 count ≤ 50 cells/mm3, were more likely to be infected with intestinal parasites. CONCLUSIONS/SIGNIFICANCE: HIV infection was mainly diagnosed at an advanced stage of immunosuppression in Lao patients. Intestinal parasite infections were highly prevalent regardless of their diarrheal status. Opportunistic infections were reported. Improving the laboratory diagnosis of intestinal parasite infections and the knowledge on their local risk factors is warranted.

Project description:Background:Refillable water containers are commonly used in rural areas of Lao PDR, and they act as Aedes mosquito breeding sites. Aedes aegypti and Ae. albopictus mosquitos are transmission vectors for the dengue virus, which causes dengue fever. Methods:Two isolated rural villages in the central part of Lao PDR were selected as study sites. In the intervention village, domestic water containers were continuously treated with a long-lasting matrix release formulation, containing pyriproxyfen, named SumiLarv®2MR. In the control village, entomological activity was monitored, but no intervention was performed. Baseline data were collected in both villages during the late rainy season (October 2017) then distributed SumiLarv®2MR disks in intervention village. This data was compared with data collected during the intervention periods in the dry season (February 2018), rainy season (July 2018 and 2019), and late rainy season (September 2018) in the region. Results:Compared with the baseline data (20.24%), the percentage of water containers infested with Ae. aegypti larvae was significantly decreased in the treated village, especially in the rainy seasons in July 2018 (4.11%; P < 0.001) and July 2019 (2.46%; P < 0.001), while the percentage of water containers infested with Ae. albopictus larvae did not decrease significantly in prevalence. No reduction in the frequency of Aedes species was seen in the control village. The Ae. albopictus liked to breed in small habitats (the median water volume of its habitats was 5?L and 10?L in the control and treated village, respectively, while the equivalent values for Ae. aegypti were 30?L and 50?L, respectively). Conclusion:The treatment of refillable water storage containers in a rural village with SumiLarv®2MR disks led to significant reductions in the Ae. aegypti population. However, the Ae. albopictus population did not decrease in either the control or treated village. This discrepancy was due to differences in habitat-seeking behaviors and preferred breeding sites such as types of water, water container, and water volume, then led to the differences in results of mosquito prevalence after SumiLarv®2MR disk treatments. The SumiLarv®2MR disk treatment was proven to be effective against the primary dengue-virus vector mosquitoes, Ae. aegypti.

Dataset Information

The determinants of vaccination in a semi-rural area of Vientiane City, Lao People's Democratic Republic: a qualitative study.

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The determinants of vaccination in a semi-rural area of Vientiane City, Lao People's Democratic Republic: a qualitative study.

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