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Qin S, Qin J, Su Q, Huang T, Zhan J, Yang X, Yang Y, He J, Lin Z, Huang X, Ye L, Liang H, Tang H, Cen P, Liang B. HIV knowledge, sexual attitudes, and PrEP-Eligible behaviors among college students in Southwest China: a cross-sectional study. BMC Infect Dis 2024; 24:827. [PMID: 39143458 PMCID: PMC11323675 DOI: 10.1186/s12879-024-09657-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 07/24/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND There is an increasing number of human immunodeficiency virus (HIV) reported cases among students in Southwest China. However, the data on HIV/sex-related knowledge, attitude toward sex, sexual behaviors, and correlates of pre-exposure prophylaxis (PrEP)-eligible behaviors among college students in this area is still limited. This study aimed to assess the prevalence of HIV/sex-related knowledge, sexual attitudes, sexual behaviors, and factors associated with PrEP-eligible behaviors among college students. METHOD An online survey from 2020 to 2021 based on a multistage stratified and cluster sampling method was conducted among college students in Southwest China, and a well-designed questionnaire collected data. Propensity score matching (PSM), logistic, and log-binomial regression were used to identify the determinants of PrEP-eligible behaviors. RESULT A total of 108,987 students participated in the survey, and 92,946 provided valid responses. 91.6% (85,145/92,946) had good HIV-related knowledge, while only 26.0% (24,137/92,946) reported awareness of sex-related knowledge. Furthermore, more than half of the participants (64.5%) held negative stances towards engaging in "one-night stand", and 58.9% (617/1,047) reported PrEP-eligible behaviors. Log-binomial regression analysis indicated that unaware of HIV-related knowledge (aPR = 1.66, 95% CI:1.22-2.26, P = 0.001), not discussing about sex with their parent(s) (aPR = 1.16, 95% CI:1.01-1.33, P = 0.021), not receiving sex-related education in school(aPR = 1.24, 95% CI: 1.07-1.45, P = 0.005), not participating in HIV/AIDS prevention activities in the past year (aPR = 1.32, 95%CI:1.09-1.60, P = 0.004), experiencing forced sex (aPR = 2.08, 95% CI: 1.19-3.63, P = 0.010), and having the drug abuse (aPR = 22.21, 95% CI:5.59-88.31, P < 0.001) were significantly associated with increased odds of PrEP-eligible behaviors. CONCLUSION College students in Southwest China exhibited suboptimal HIV/sex-related knowledge, received limited sex education, reported conservative attitudes towards casual sex, and significant PrEP-eligible behaviors. These findings suggest that sexually experienced college students who were unaware of HIV-related knowledge, lacked sex education, experienced forced sex, and reported drug abuse were the key individuals for evaluating eligibility for PrEP initiation, and interventions aimed at increasing awareness of HIV/sex-related knowledge, promoting participation in sex education, addressing issues related to forced sex and tackling drug abuse could contribute to reducing the incidence of PrEP-eligible behaviors among college students.
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Affiliation(s)
- Shiyu Qin
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Jiao Qin
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Qiuqian Su
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Ting Huang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Junyu Zhan
- Nanning Center for Disease Control and Prevention, Nanning, 530023, Guangxi, China
| | - Xi Yang
- Nanning Center for Disease Control and Prevention, Nanning, 530023, Guangxi, China
| | - Yuanhong Yang
- Nanning Center for Disease Control and Prevention, Nanning, 530023, Guangxi, China
| | - Jinfeng He
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Zhifeng Lin
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
- Nanning Center for Disease Control and Prevention, Nanning, 530023, Guangxi, China
| | - Xinju Huang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Li Ye
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
- Nanning Center for Disease Control and Prevention, Nanning, 530023, Guangxi, China
| | - Hao Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China
- Nanning Center for Disease Control and Prevention, Nanning, 530023, Guangxi, China
| | - Hongyang Tang
- Nanning Center for Disease Control and Prevention, Nanning, 530023, Guangxi, China.
| | - Ping Cen
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China.
- Nanning Center for Disease Control and Prevention, Nanning, 530023, Guangxi, China.
| | - Bingyu Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021, Guangxi, China.
- Collaborative Innovation Centre of Regenerative Medicine and Medical Bioresource Development and Application Co-constructed by the Province and Ministry, Life Science Institute, Guangxi Medical University, Nanning, 530021, Guangxi, China.
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Mohd Tohit NF, Haque M. Forbidden Conversations: A Comprehensive Exploration of Taboos in Sexual and Reproductive Health. Cureus 2024; 16:e66723. [PMID: 39139803 PMCID: PMC11319820 DOI: 10.7759/cureus.66723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2024] [Indexed: 08/15/2024] Open
Abstract
This scoping review aims to comprehensively explore the landscape of taboos and their impact on sexual and reproductive health. Titled "Forbidden Conversations," it delves into the intricate web of societal, cultural, and religious norms that have contributed to the elusive and often stigmatized nature of sexual and reproductive health topics. The review navigates through the multifaceted dimensions of these taboos, shedding light on their impact on individuals, communities, and public health while advocating for a paradigm shift toward open, inclusive, and informed dialogue. The analysis within this review spans a decade, capturing the most recent and relevant literature to map the landscape of taboos in sexual and reproductive health. It explores the persistent societal apprehensions and subsequent stigmatization surrounding topics such as menstruation, contraception, fertility, sexual orientation, and gender identity. The review contextualizes the multifaceted challenges presented by these prevailing norms by tracing historically rooted taboos and their evolution across different cultures and contexts. The scoping review identifies the profound implications of these taboos on public health, highlighting how they contribute to disparities in access to healthcare, perpetuate misinformation, and infringe upon the fundamental rights of individuals. It addresses the challenges in sexual education, emphasizing how these taboos impede comprehensive understanding and enforcement of sexual and reproductive health rights among adolescents and young adults. The intersectional approach taken in this review situates these taboos within broader systems of inequality, emphasizing the compounded impact they have on marginalized populations. Through this comprehensive exploration, the review aims to provide actionable insights and identify existing research, policy, and practice gaps. It seeks to lay the foundation for future initiatives that advocate for destigmatization, empowerment, and equity in sexual and reproductive health. Ultimately, "Forbidden Conversations" aims to steer the conversation toward openness and inclusivity while advocating for unbiased, comprehensive sexual and reproductive healthcare with dignity for all individuals.
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Affiliation(s)
- Nor Faiza Mohd Tohit
- Department of Community Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, MYS
| | - Mainul Haque
- Department of Research, Karnavati Scientific Research Center (KSRC) School of Dentistry, Karnavati University, Gandhinagar, IND
- Department of Pharmacology and Therapeutics, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, MYS
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Habito M, Hennegan J, Rasphone K, Phanthachith S, Sihanath T, Akiyama M, Azzopardi PS, Kennedy E, Kosaikanont R. From 'Pen Sao' to 'Tue Pa': Understanding diverse pathways to adolescent pregnancy in Lao People's Democratic Republic through qualitative investigation with girls in Vientiane Capital, Vientiane Province, and Luang Namtha. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002825. [PMID: 38306586 PMCID: PMC10836915 DOI: 10.1371/journal.pgph.0002825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 12/22/2023] [Indexed: 02/04/2024]
Abstract
Adolescent birth rates in Lao People's Democratic Republic (PDR) remain the highest in Southeast Asia. There is growing recognition that adolescent pregnancy in Lao PDR is occurring within and outside marriage, but there is a lack of robust qualitative evidence to understand girls' pathways to adolescent pregnancy and contributing factors, especially outside of union (cohabitation or marriage). This study aimed to improve understanding of pathways to adolescent pregnancy in Lao PDR among girls who experienced pregnancy at age 18 or below. We conducted participatory timeline interviews with 57 girls from urban, peri-urban, and rural communities in Vientiane Capital, Vientiane Province, and Luang Namtha, and follow-up interviews with a subset of 20 girls. We identified six pathways to pregnancy, including pathways outside (n = 23) and within union (n = 34). Outside-union pathways diverged according to the nature of sex preceding pregnancy (consensual/pressured, or forced), and pregnancy intention (unplanned, partner-led, or planned). Within-union pathways diverged according to the nature of the relationship before union (romantic or no romantic relationship/arranged union), who initiated the union (couple/girl, parent/partner, or pressured), and pregnancy intention. Factors contributing to girls' pregnancy included barriers to sexual and reproductive health (SRH) information and services; partner's control over reproductive decision-making; male sexual entitlement and alcohol use driving pressured/forced sex; cultural acceptance of child marriage and early union; and attitudes and norms regarding sex and pregnancy outside of union. Our findings support strengthening comprehensive sexuality education, including a focus on addressing myths about contraception, building girls' and boys' communication skills, engaging in respectful relationships, and addressing harmful gender norms. Our findings also highlight the need to improve girls' access to adolescent-responsive SRH services, address harmful substance use, challenge sociocultural barriers to young people accessing SRH information and services, and respond to sociocultural and financial drivers of child marriage/early union that contribute to adolescent pregnancy.
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Affiliation(s)
- Marie Habito
- Global Adolescent Health Group, Burnet Institute, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Julie Hennegan
- Global Adolescent Health Group, Burnet Institute, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | | | | | | | - Maki Akiyama
- UNFPA Asia Pacific Regional Office, Bangkok, Thailand
| | - Peter S Azzopardi
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Telethon Kids Institute, Adelaide, South Australia, Australia
| | - Elissa Kennedy
- Global Adolescent Health Group, Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Castro CA, Monterrosa-Blanco A, Rodríguez LL, Castiblanco A, Bernal L, Ladino MJ, Pinilla D, Melo C, Baquero F. Knowledge and attitudes regarding contraceptive methods and sex education in students and parents of eight Colombian schools 2020-2021: a mixed methods study. LANCET REGIONAL HEALTH. AMERICAS 2024; 30:100678. [PMID: 38322782 PMCID: PMC10844851 DOI: 10.1016/j.lana.2024.100678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 01/11/2024] [Accepted: 01/11/2024] [Indexed: 02/08/2024]
Abstract
Background In Colombia, the average age of first sexual intercourse is between 14 and 15, and it has one of the highest fertility rates among adolescents in Latin America, which reflects poor access to health services and a lack of knowledge about contraception. Some laws support comprehensive sex education as a learning process that families and schools should provide. The objective of this work was to assess the frequency of adequate knowledge and attitudes of acceptance towards contraception in students, their associated factors, sexual behaviours in sexually active students, and experiences with sex education. Methods Mixed methods study consisting of an analytical cross-sectional study and a qualitative hermeneutic phenomenological study. The former included students who completed a questionnaire with sociodemographic variables, surveys on knowledge and attitudes toward contraception, and questions about sexual behaviour. Focus groups were used in the qualitative study to evaluate students' and parents' sex education experiences. Findings 827 students were surveyed, of whom 52.3% had adequate knowledge about contraceptives and 80.1% had attitudes of acceptance. Talking with parents about sex education, receiving sex education, and being in the eleventh grade increased the likelihood of having adequate knowledge. Each year of age, being male, being a victim of forced displacement, and studying in a public school were associated with lower possibilities of attitudes of acceptance. Using condoms, compared to other contraceptives, was associated with less adequate knowledge and attitudes of acceptance (p < 0.05). Experiences with sex education, contraception, and sexual and reproductive rights were three emerging categories in the focus groups. Interpretation In a group of Colombian high school students, half of them had adequate knowledge, eight out of 10 had attitudes of acceptance about contraception, and both were associated with having received sex education. Nevertheless, different types of barriers to sexual education were identified at home and in schools. The results will allow the generation of educational policies that modify the educational model as well as new strategies by health professionals to raise awareness about responsible sexuality. Funding This project was financed by internal research of the Fundación Universitaria de Ciencias de la Salud-FUCS (DI-I-0392-20).
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Affiliation(s)
| | | | | | | | - Liliana Bernal
- Fundación Universitaria de Ciencias de la Salud - FUCS, Bogota, Colombia
| | - María José Ladino
- Nursing School, Fundación Universitaria de Ciencias de la Salud - FUCS, Bogota, Colombia
| | - Diana Pinilla
- School of Medicine, Fundación Universitaria de Ciencias de la Salud - FUCS, Bogota, Colombia
| | - Carlos Melo
- Fundación Universitaria de Ciencias de la Salud - FUCS, Bogota, Colombia
| | - Ferney Baquero
- Fundación Universitaria de Ciencias de la Salud - FUCS, Bogota, Colombia
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Akatukwasa C, Nyakato VN, Achen D, Kemigisha E, Atwine D, Mlahagwa W, Neema S, Ruzaaza GN, Coene G, Rukundo GZ, Michielsen K. Level and comfort of caregiver–young adolescent communication on sexual and reproductive health: a cross-sectional survey in south-western Uganda. BMC Public Health 2022; 22:2129. [PMCID: PMC9675188 DOI: 10.1186/s12889-022-14561-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 11/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background Communication on sexual and reproductive health (SRH) between caregivers and their young adolescent children plays a significant role in shaping attitudes and behaviours that are critical to laying the foundations for positive and safe SRH behaviours in later adolescence. Nevertheless, this communication is often limited, particularly in countries where adolescent sexuality is taboo. This study assessed the topics discussed (‘level’) and the comfort of caregivers with communicating with young adolescents on SRH, and their correlates. Methods A cross-sectional survey was conducted among 218 caregivers of young adolescents (10–14 years) in Mbarara district of south-western Uganda in January and February 2020. Participants were selected through consecutive sampling. A structured, pre-tested questionnaire administered by interviewers was used for data collection. The surveys were computer-assisted using Kobo Collect software. Data was exported to STATA 14 for analysis. Level of SRH communication was measured based on 10 SRH communication topics, while comfort was based on 9 SRH discussion topics. Bivariate and multivariate linear regression analyses were conducted to determine correlates of level of, and comfort with, SRH communication P-value < 0.05 was considered for statistical significance. Results The mean number of topics that caregivers discussed was 3.9 (SD = 2.7) out of the 10 SRH topics explored. None of the respondents discussed all the topics; 2% reported ever discussing nine topics with their young adolescent, while 3.5% reported never discussing any of the topics. General health and bodily hygiene (89.9%) and HIV/AIDS and other sexually transmitted infections (STIs) (77.5%) were the most commonly discussed, while night emissions in boys (4.3%) and condoms (8.3%) were least discussed. The majority of caregivers (62%) reported a high level of comfort with discussing SRH. The mean comfort score was 21.9 (SD = 3.8). In general, the level of SRH communication increased with an increase in comfort with SRH communication β = 0.22 (0.04); 95% CI = (0.15, 0.30). The level of comfort with SRH communication decreased with an increase in the number of YAs in a household β = -0.92 (0.38); 95%CI = (-1.66,-0.18). Conclusion Overall, the level of SRH communication is low and varies according to the number of SRH topics. Caregivers’ comfort with SRH communication with YAs was a significant correlate of SRH communication. This justifies the need for interventions that aim to improve caregivers’ comfort with communicating with young adolescents about SRH. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14561-3. Communication between parents and children about sexual and reproductive health (SRH) during the early adolescence stage (10–14 years) plays a significant role in creating positive reproductive health outcomes in later adolescence and adulthood. We conducted surveys in rural areas of Mbarara district among 218 pairs of caregivers and their children aged 10–14 years between January and February 2020. The purpose of the study was to understand whether there is communication between the two, and how comfortable they felt having discussions about SRH. We also asked caregivers and their children about their knowledge of SRH, and how they generally felt about SRH for young people. This study, however, reports only results from caregivers. We found that, on average, caregivers discussed 4 of the 10 SRH topics explored in this survey with their child, and that the majority of the caregivers reported being very comfortable discussing SRH—especially general health and bodily hygiene—with their children. On the whole, we found that caregivers’ SRH communication was largely influenced by their comfort with discussing SRH with their adolescent child. The level of comfort was influenced by the number of young adolescents living in a household. However, there is no clear justification for this finding from existing literature. In conclusion, there is a need for interventions that facilitate improvement of communication on SRH between parents/caregivers and young adolescents. These should focus on improving comfort levels by promoting communication skills for caregivers and emphasizing value clarification.
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Affiliation(s)
- Cecilia Akatukwasa
- grid.5342.00000 0001 2069 7798International Centre for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium ,grid.33440.300000 0001 0232 6272Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Viola N. Nyakato
- grid.33440.300000 0001 0232 6272Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda ,grid.451863.d0000 0001 2194 5036Nordic Africa Institute, Uppsala, Sweden
| | - Dorcus Achen
- grid.33440.300000 0001 0232 6272Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda ,grid.8767.e0000 0001 2290 8069Centre of Expertise Gender, Diversity and Intersectionality, Vrije Universitet Brussels, Brussels, Belgium
| | - Elizabeth Kemigisha
- grid.33440.300000 0001 0232 6272Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Daniel Atwine
- grid.33440.300000 0001 0232 6272Department of Community Health, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Wendo Mlahagwa
- grid.33440.300000 0001 0232 6272Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Stella Neema
- grid.11194.3c0000 0004 0620 0548Department of Sociology and Anthropology, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Gad Ndaruhutse Ruzaaza
- grid.33440.300000 0001 0232 6272Department of Community Health, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Gily Coene
- grid.8767.e0000 0001 2290 8069Centre of Expertise Gender, Diversity and Intersectionality, Vrije Universitet Brussels, Brussels, Belgium
| | - Godfrey Z. Rukundo
- grid.33440.300000 0001 0232 6272Department of Psychiatry, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Kristien Michielsen
- grid.5342.00000 0001 2069 7798International Centre for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Okeke SR. "I always prefer to withdraw than use a condom": contextualising condomless sex among East Asian and sub-Saharan African international students in Sydney. Arch Public Health 2022; 80:20. [PMID: 34986875 PMCID: PMC8729151 DOI: 10.1186/s13690-021-00777-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Incidence and prevalence of blood-borne viruses and sexually transmissible infections among young people continue to necessitate population-based studies to understand how contextualised sexual health services can be developed and implemented to promote protective behaviours such as consistent condom use. This study examined condomless sexual practice among a sample of East Asian and sub-Saharan African international university students in Sydney, Australia. METHODS This qualitative study was methodologically guided by interpretative phenomenological analysis. Data was provided by 20 international students sampled from five universities in Sydney, who participated in either face-to-face or telephone semi-structured in-depth interviews. The interview sessions were audio-recorded, transcribed verbatim, coded in NVivo and analysed using reflexive thematic analysis. RESULTS Condomless sexual practices appear to be common among the study group based on participants' self-reports of their own practices and the practices of friends and peers. Three themes contextualising condomless among the study participants were generated from the interview transcripts: (1) unanticipated sex, condom related stigma and alcohol use (2) pleasure-seeking, curiosity and intimacy (3) condomless sex as a gendered practice. CONCLUSIONS The result of this study has implications for public health research, practice and policy around design, implementation and evaluation of multi-layered and population-specific sexual health services that are tailored to addressing the needs of international students, who migrate from traditional sexual cultures to Australia, where sexual norms are more liberal.
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Bromage I, Wright EP, Kounnavong S, Sychareun V, Venroij L. Research provides evidence for health policy in Lao PDR. Glob Health Action 2020; 13:1791415. [PMID: 32741351 PMCID: PMC7480484 DOI: 10.1080/16549716.2020.1791415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
| | - E Pamela Wright
- Guelph International Health Consulting: Amsterdam , The Netherlands
| | - Sengchanh Kounnavong
- Director, Lao Tropical and Public Health Institute, Ministry of Health , Vientiane Capital, Lao PDR
| | - Vanphanom Sychareun
- Dean, Faculty of Public Health, University of Health Sciences , Vientiane Capital, Lao PDR
| | - Léonie Venroij
- LEARN Program Manager, MCNV Laos , Vientiane Capital, Lao PDR
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