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Nonaka D, Inthavong N, Takahashi K, Chanthakoumane K, Toyama Y, Luangphaxay C, Pongvongsa T, Kounnavong S. Primary health care situations in remote rural villages of the Savannakhet province, Lao People's Democratic Republic. Trop Med Health 2022; 50:90. [PMID: 36443857 PMCID: PMC9703750 DOI: 10.1186/s41182-022-00482-9] [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: 08/18/2022] [Accepted: 11/19/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To improve the health of the rural population in the Lao People's Democratic Republic (Lao PDR), the government has emphasized a primary health care approach in the Health Sector Reform Strategy by 2025. The objective of the present study was to describe the health-related situations of remote rural villages of the Lao PDR to inform strategies for promoting primary health care in such villages. METHODS Ten remote rural villages were purposively selected from the catchment areas of two health centers in the Xepon district, Savannakhet province. The surveyors collected data by conducting a questionnaire-based interview with village health volunteers and by observing the village environment in 2018. The survey focused on village situations on the eight elements of primary health care (health education; food supply and nutrition; safe water and basic sanitation; maternal and child health care; immunization; prevention and control of locally endemic diseases; treatment of common diseases and injuries; and provision of essential drug). RESULTS The common health problems were diarrhea, followed by malaria, and cough. The identified possible risk factors for the health problems were not washing hands with soap, open defecation, not boiling drinking water, not exclusively breastfeeding, presence of animal feces on the village ground, absence of garbage management system, not using a bed net when sleeping in the forest, and exposure to indoor cooking and tobacco smoke. In many villages, villagers were not able to eat enough food and did not eat protein-rich food and vegetables daily. CONCLUSIONS Potential risk factors for the reported common health problems were often prevalent in the study villages. Villagers can address most of these risk factors, as interventions to address such risk factors do not require a large financial input. There is a need for intersectoral actions between the health and other sectors to address food shortages and indoor air pollution due to indoor cooking using biomass fuel.
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Affiliation(s)
- Daisuke Nonaka
- grid.267625.20000 0001 0685 5104Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Nouhak Inthavong
- grid.415768.90000 0004 8340 2282Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People’s Democratic Republic
| | - Kenzo Takahashi
- grid.264706.10000 0000 9239 9995Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Ketmany Chanthakoumane
- grid.415768.90000 0004 8340 2282Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People’s Democratic Republic
| | - Yuko Toyama
- grid.267625.20000 0001 0685 5104Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Chanthaly Luangphaxay
- grid.415768.90000 0004 8340 2282Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People’s Democratic Republic
| | - Tiengkham Pongvongsa
- grid.415768.90000 0004 8340 2282Savannakhet Provincial Health Department, Ministry of Health, Savannakhet, Lao People’s Democratic Republic
| | - Sengchanh Kounnavong
- grid.415768.90000 0004 8340 2282Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People’s Democratic Republic
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Pooseesod K, Parker DM, Meemon N, Lawpoolsri S, Singhasivanon P, Sattabongkot J, Cui L, Phuanukoonnon S. Ownership and utilization of bed nets and reasons for use or non-use of bed nets among community members at risk of malaria along the Thai-Myanmar border. Malar J 2021; 20:305. [PMID: 34229653 PMCID: PMC8259116 DOI: 10.1186/s12936-021-03837-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/27/2021] [Indexed: 11/22/2022] Open
Abstract
Background With the goal for malaria elimination in Thailand set for 2024, increased coverage and utilization of bed net, especially insecticide-treated net (ITN) or long-lasting insecticidal net (LLIN) is a key strategy. This study aims to provide the necessary information about bed net ownership and utilization among the population at risk of malaria living along the Thai-Myanmar border in Tak province. Methods A cross-sectional study was conducted using a mixed-method approach in 331 households from 5 hamlets in the villages of the Thai-Myanmar border. The research tools included a questionnaire, bed net inspection, and semi-structured interviews. Logistic regression was used to explore the sociodemographic factors associated with bed net utilization. The qualitative analysis employed a thematic analysis approach. Results This survey found that 98.5% of households had at least one bed net per household, and 74.3% had at least one ITN/LLIN. However, only 30.8% of households reached the standard policy set by the Minister of Public Health of one ITN/LLINs per two persons. Most residents used bed net (92.1% used in the previous night and 80.9% used every day). For those using bed nets, however, 61.9% used ITNs or LLINs the night before and 53.1% used them every day. Nonetheless, the usage rates of bed nets (any type) in the previous night among children and pregnant women were high, reaching 95.3% and 90.0%, respectively. Seven explanatory variables showed statistically significant associations with bed net use every day, including: “not staying overnight in the forest or the field”, “sleeping pattern based on gender”, “sufficient numbers of bed nets to cover all sleeping spaces”, “preference for free bed nets”, “age”, “gender”, and “SES score” showed statistically significant association with bed net use every day. The major reasons for the regular use of bed nets in both household and the forest were to prevent mosquito biting. The reasons for not using bednets in the household were discomfort feelings from heat, perception of unnecessity due to low mosquito density, whereas the reason for not using bed nets in the forest was inconvenience. Conclusion Despite that overall coverage and usage of bed nets was high, only one third reached the standard level specified by the policy. Overnight in the forest, the dissatisfaction with the quality of free bed nets, insufficient number of bed nets, sleeping alone, male gender, age more than 10 years, low socioeconomic status, discomfort from heat, perception of no benefits of bed nets due to low mosquito density, and inconvenience were factors influencing bed net use. Maintaining high coverage and utility rate of bed nets should be a priority for the malaria high-risk population. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03837-5.
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Affiliation(s)
- Kasama Pooseesod
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand.,Faculty of Public Health, Thammasat University, Bangkok, Thailand
| | - Daniel M Parker
- Department of Population Health & Disease Prevention, Program in Public Health Susan and Henry Samueli College of Health Sciences, University of California, Irvine, USA
| | - Natthani Meemon
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | - Saranath Lawpoolsri
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand
| | - Pratap Singhasivanon
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand.,Faculty of Tropical Medicine, SEAMEO TROPMED Regional Centre for Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand
| | - Jetsumon Sattabongkot
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand
| | - Liwang Cui
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Suparat Phuanukoonnon
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand. .,Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand.
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Edwards HM, Sriwichai P, Kirabittir K, Prachumsri J, Chavez IF, Hii J. Transmission risk beyond the village: entomological and human factors contributing to residual malaria transmission in an area approaching malaria elimination on the Thailand-Myanmar border. Malar J 2019; 18:221. [PMID: 31262309 PMCID: PMC6604376 DOI: 10.1186/s12936-019-2852-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 06/19/2019] [Indexed: 11/12/2022] Open
Abstract
Background A mixed methods study was conducted to look at the
magnitude of residual malaria transmission (RMT) and factors contributing to low (< 1% prevalence), but sustained transmission in rural communities on the Thai–Myanmar border. Methods A cross-sectional behaviour and net survey, observational surveys and entomological collections in both villages and forested farm huts frequented by community members for subsistence farming practices were conducted. Results Community members frequently stayed overnight at subsistence farm huts or in the forest. Entomological collections showed higher biting rates of primary vectors in forested farm hut sites and in a more forested village setting compared to a village with clustered housing and better infrastructure. Despite high levels of outdoor biting, biting exposure occurred predominantly indoors, particularly for non-users of long-lasting insecticidal nets (LLINs). Risk of biting exposure was exacerbated by sub-optimal coverage of LLINs, particularly in subsistence farm huts and in the forest. Furthermore, early waking hours when people had left the safety of their nets coincided with peaks in biting in later morning hours. Conclusions Entomological and epidemiological findings suggest drivers and modulators of sustained infection prevalence in the area to be: higher mosquito abundance in forested areas where LLINs were used less frequently or could not be used; late sleeping and waking times coinciding with peak biting hours; feeding preferences of Anopheles taking them away from contact with LLIN and indoor residual spraying (IRS), e.g. exophagy and zoophagy; non-use of LLIN and use of damaged/torn LLIN; high population movement across the border and into forested areas thereby increasing risk of exposure, decreasing use of protection and limiting access to healthcare; and, Plasmodium vivax predominance resulting in relapse(s) of previous infection. The findings highlight gaps in current intervention coverage beyond the village setting. Electronic supplementary material The online version of this article (10.1186/s12936-019-2852-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hannah M Edwards
- Department of Disease Epidemiology, Imperial College London, London, UK. .,Malaria Consortium Asia, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand.
| | - Patchara Sriwichai
- Department of Entomology, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand
| | - Kirakorn Kirabittir
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand
| | - Jetsumon Prachumsri
- Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand
| | - Irwin F Chavez
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand
| | - Jeffrey Hii
- Department of Disease Epidemiology, Imperial College London, London, UK
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Inthavong N, Nonaka D, Kounnavong S, Iwagami M, Phommala S, Kobayashi J, Hongvanthong B, Pongvongsa T, Brey PT, Kano S. Individual and household factors associated with incidences of village malaria in Xepon district, Savannakhet province, Lao PDR. Trop Med Health 2017; 45:36. [PMID: 29151802 PMCID: PMC5678595 DOI: 10.1186/s41182-017-0077-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/25/2017] [Indexed: 11/18/2022] Open
Abstract
Background In the Lao PDR, the incidence of malaria greatly differs among villages even within a subdistrict, and the reasons for this difference are poorly understood. The objective of this study was to identify differences in villagers’ behavior and the household environment between villages with high incidences and those with low incidences of malaria in a rural district of the Lao PDR. Methods A case-control study was conducted in Xepon district, Savannakhet province. Case villages were defined as those with a high incidence (> 10 cases per 1000 population per year), and control villages were those with a low incidence (0–10 cases per 1000 population per year). Data were collected from 178 households in the six case villages and six control villages between December 2016 and January 2017. The data collection consisted of an interview survey with the heads of households and an observational survey in and around the house. Logistic regression was used to assess the association between the case-control status and individual-level behavioral factors and household-level environmental factors adjusted for socio-demographic and economic factors. Results Compared to the household members in the control villages, household members in the case villages were significantly more likely to work at night in the forest (adjusted odds ratio 1.95; 95% confidence interval 1.28 to 2.98) and more likely to sleep overnight in the forest (adjusted odds ratio 1.94; 95% confidence interval 1.13 to 3.33). Additionally, compared to the households in the control villages, households in the case villages were significantly more likely to have an open space on the house surface (adjusted odds ratio 3.64; 95% confidence interval 1.68 to 7.84). Conclusions There were significant differences in nighttime working and sleeping behaviors in the forest and the presence of an open space on the house surface in the case versus control villages. These differences can partly explain the difference in the incidences of malaria among the villages. The Lao National Malaria Control Program should recommend that villagers use personal protection when working and sleeping in the forest and to reduce any open space on the house surfaces.
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Affiliation(s)
- Nouhak Inthavong
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Uehara 207, Nishihara-cho, Okinawa, 903-0215 Japan.,SATREPS Project for Parasitic Diseases, Vientiane, Lao People's Democratic Republic.,National Institute of Public Health, Ministry of Health, Ban Kaognot, Samsenthai Road, Sisattanak District, Vientiane, Lao People's Democratic Republic
| | - Daisuke Nonaka
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Uehara 207, Nishihara-cho, Okinawa, 903-0215 Japan.,SATREPS Project for Parasitic Diseases, Vientiane, Lao People's Democratic Republic
| | - Sengchanh Kounnavong
- National Institute of Public Health, Ministry of Health, Ban Kaognot, Samsenthai Road, Sisattanak District, Vientiane, Lao People's Democratic Republic
| | - Moritoshi Iwagami
- SATREPS Project for Parasitic Diseases, Vientiane, Lao People's Democratic Republic.,Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan.,Institut Pasteur du Laos, Ministry of Health, Sisattanak District, Vientiane, Lao People's Democratic Republic
| | - Souraxay Phommala
- National Institute of Public Health, Ministry of Health, Ban Kaognot, Samsenthai Road, Sisattanak District, Vientiane, Lao People's Democratic Republic
| | - Jun Kobayashi
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Uehara 207, Nishihara-cho, Okinawa, 903-0215 Japan.,SATREPS Project for Parasitic Diseases, Vientiane, Lao People's Democratic Republic
| | - Bouasy Hongvanthong
- SATREPS Project for Parasitic Diseases, Vientiane, Lao People's Democratic Republic.,Center of Malariology, Parasitology and Entomology, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | - Tiengkham Pongvongsa
- SATREPS Project for Parasitic Diseases, Vientiane, Lao People's Democratic Republic.,Savannakhet Provincial Health Department, Thahea village, Kaysone-Phomvihan District, Savannakhet, Lao People's Democratic Republic
| | - Paul T Brey
- SATREPS Project for Parasitic Diseases, Vientiane, Lao People's Democratic Republic.,Institut Pasteur du Laos, Ministry of Health, Sisattanak District, Vientiane, Lao People's Democratic Republic
| | - Shigeyuki Kano
- SATREPS Project for Parasitic Diseases, Vientiane, Lao People's Democratic Republic.,Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan
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Pongvongsa T, Nonaka D, Iwagami M, Nakatsu M, Phongmany P, Nishimoto F, Kobayashi J, Hongvanthon B, Brey PT, Moji K, Mita T, Kano S. Household clustering of asymptomatic malaria infections in Xepon district, Savannakhet province, Lao PDR. Malar J 2016; 15:508. [PMID: 27756391 PMCID: PMC5069939 DOI: 10.1186/s12936-016-1552-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 10/05/2016] [Indexed: 11/10/2022] Open
Abstract
Background In the Lao PDR, malaria morbidity and mortality have remarkably decreased over the past decade. However, asymptomatic infections in rural villages contribute to the on-going local transmission. The primary objective of this study was to explore the characteristics of infections in a malaria-endemic district of the Lao PDR. The specific objectives were to investigate the prevalence and species of malaria parasites using molecular methods and to assess individual and household parasite levels and the characteristics associated with malaria infection. Methods The study population included 870 participants from 236 households in 10 villages of the Xepon district. Interviews, blood examinations and body temperature measurements were conducted between August and September 2013. A multilevel logistic regression model, with adjustment for clustering effects, was used to assess the association between predictor variables and an outcome variable (malaria infection status as principally determined by PCR). The predictive factors included individual-level factors (age, gender, past fever episode, and forest activity during night time) and household-level factors (household member size, household bed net usage/density and a household with one other malaria-infected member). Results Fifty-two participants (including 26 children) tested positive (positive rate: 6.0 %): Plasmodium falciparum mono-infection was the most common infection (n = 41, 78.8 %), followed by P. falciparum and Plasmodium vivax mixed infections (n = 9, 17.3 %). The majority of infected participants (n = 42, 80.8 %) had no fever episodes in the two previous weeks or a measurable fever (>37 °C) at the time of survey. Living in a household with one other malaria-infected member significantly increased the odds of infection (odds ratio 24.33, 95 % confidence interval 10.15–58.32). Among the 40 households that had at least one infected member, nine households were responsible for 40.4 % of the total infections. Conclusions Plasmodium vivax was detected more frequently than it was reported from the district hospital. Most infections were asymptomatic and sub-microscopic and were highly clustered within households. To further eliminate malaria in Xepon and other similar settings in the country, the National Malaria Control Programme should consider household-based strategies, including reactive case detection targeting the household members of index cases. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1552-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tiengkham Pongvongsa
- Savannakhet Provincial Health Department, Phonsavangnuea Village, Kaysone-Phomvihan District, Savannakhet, Lao PDR.,Department of Molecular and Cellular Parasitology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,SATREPS Project for Parasitic Diseases, Vientiane, Lao PDR
| | - Daisuke Nonaka
- SATREPS Project for Parasitic Diseases, Vientiane, Lao PDR. .,Department of Global Health, School of Health Sciences, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan.
| | - Moritoshi Iwagami
- SATREPS Project for Parasitic Diseases, Vientiane, Lao PDR.,Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.,Institut Pasteur du Laos, Sisattanak District, Vientiane, Lao PDR
| | - Masami Nakatsu
- SATREPS Project for Parasitic Diseases, Vientiane, Lao PDR.,Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Panom Phongmany
- Savannakhet Provincial Health Department, Phonsavangnuea Village, Kaysone-Phomvihan District, Savannakhet, Lao PDR
| | - Futoshi Nishimoto
- Graduate School of Tropical Medicine and Global Health, Nagasaki University, 1-12-4 Sakamoto, Nagasaki-shi, Nagasaki, 852-8523, Japan
| | - Jun Kobayashi
- SATREPS Project for Parasitic Diseases, Vientiane, Lao PDR.,Department of Global Health, School of Health Sciences, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan
| | - Bouasy Hongvanthon
- SATREPS Project for Parasitic Diseases, Vientiane, Lao PDR.,Center of Malariology, Parasitology and Entomology, Ministry of Health, Vientiane, Lao PDR
| | - Paul T Brey
- SATREPS Project for Parasitic Diseases, Vientiane, Lao PDR.,Institut Pasteur du Laos, Sisattanak District, Vientiane, Lao PDR
| | - Kazuhiko Moji
- Graduate School of Tropical Medicine and Global Health, Nagasaki University, 1-12-4 Sakamoto, Nagasaki-shi, Nagasaki, 852-8523, Japan
| | - Toshihiro Mita
- Department of Molecular and Cellular Parasitology, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,SATREPS Project for Parasitic Diseases, Vientiane, Lao PDR
| | - Shigeyuki Kano
- SATREPS Project for Parasitic Diseases, Vientiane, Lao PDR.,Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.,Institut Pasteur du Laos, Sisattanak District, Vientiane, Lao PDR
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