Gray A.Z.,University of Melbourne |
Gray A.Z.,Royal Melbourne Hospital |
Gray A.Z.,Murdoch Childrens Research Institute |
Soukaloun D.,Mahosot Hospital |
Soumphonphakdy B.,Mahosot Hospital
American Journal of Tropical Medicine and Hygiene | Year: 2017
Strategies to improve the quality of hospital care are needed if ongoing gains in child health and survival are to be made. We previously reported on improvements in the quality of case management in hospitals following a guideline-based intervention in Lao PDR, with variation in the degree of change achieved between clinical conditions. This study aims to understand the factors that influenced the uptake of the guideline-based intervention, and its impact on care. This qualitative study was embedded in a mixed-methods evaluation of guideline implementation in nine hospitals in Lao PDR. Focus groups and individual interviews were conducted with 70 health staff from central, provincial, and district hospitals. The interview guide was based on the Theoretical Domains Framework. Inductive content analysis was performed on interview transcripts to identify themes, supported by field notes from the intervention. Findings were triangulated against previously reported quantitative outcomes using driver diagrams. Key influences on guidelines uptake related to the guideline and intervention (filling a void, physical accessibility, comprehensibility, training in guideline use), health staff (behavior regulation, trust in guidelines, and beliefs about consequences), and the environment (social influences particularly consensus and incorporation into clinical norms). The major barrier was family preference for treatments in conflict with guideline recommendations. This study identifies contextual factors that explain, as well as validate previously identified improvements in care following guideline implementation in Lao PDR. It provides novel understanding of why the same intervention may have a differential impact on different clinical conditions. © 2017 by The American Society of Tropical Medicine and Hygiene.
Sayasone S.,National Institute of Public Health |
Sayasone S.,Swiss Tropical and Public Health Institute |
Sayasone S.,University of Basel |
Mak T.K.,Swiss Tropical and Public Health Institute |
And 10 more authors.
PLoS Neglected Tropical Diseases | Year: 2011
Background:Detailed investigations of multiparasitism are scarce in the Mekong River basin. We assessed helminth (trematode, nematode, and cestode), and intestinal protozoa infections, and multiparasitism in random population samples from three different eco-epidemiological settings in Champasack province, southern Lao People's Democratic Republic (Lao PDR), and determined underlying risk factors.Methodology:Two stool samples were collected from 669 individuals aged ≥6 months over consecutive days and examined for helminth infections using the Kato-Katz method. Additionally, one stool sample per person was subjected to a formalin-ethyl acetate concentration technique for diagnosis of helminth and intestinal protozoa infections. Questionnaires were administered to obtain individual and household-level data pertaining to behavior, demography and socioeconomic status. Risk factors for hepato-biliary and intestinal parasitic infections and multiparasitism were determined using multiple logistic regressions analyses.Principal Findings:Multiple species intestinal parasite infections were common: 86.6% of the study participants harbored at least two and up to seven different parasites concurrently. Regarding nematode infections, hookworm was the most prevalent species (76.8%), followed by Ascaris lumbricoides (31.7%) and Trichuris trichiura (25.0%). Regarding trematodes, Opisthorchis viverrini and Schistosoma mekongi infections were found in 64.3% and 24.2% of the participants, respectively. Infections with intestinal protozoa were rare.Conclusions/Significance:There is a pressing need to intensify and sustain helminth control interventions in the southern part of Lao PDR. Given the high prevalence with nematode and trematode infections and the extent of multiparasitism, preventive chemotherapy is warranted. This intervention should be coupled with health education and improved access to clean water and adequate sanitation to consolidate morbidity control and enhance sustainability. © 2011 Sayasone et al.
PubMed | Hiroshima Bunka Gakuen University, National Institute of Public Health, Suzuka University of Medical Science, Mahosot Hospital and Mie University
Type: Journal Article | Journal: PloS one | Year: 2016
Increasing age is associated with elevated risk of non-communicable diseases, including dementia and Alzheimers disease (AD). The apolipoprotein E (APOE) 4 allele is a risk factor not only for AD, but also for cognitive decline, depressive symptoms, stroke, hypertension, coronary heart disease, cardiovascular disease, and diabetes. The Lao Peoples Democratic Republic (Laos) is undergoing development; consequently, life expectancy has risen. To evaluate the future risk of non-communicable diseases, we investigated APOE genotypes and anthropometric characteristics in the Laotian population.Subjects were 455 members of the Lao Loum majority and 354 members of ethnic minorities. APOE genotypes, anthropometric characteristics, blood pressure, and blood glucose were recorded. To compare individual changes, health examination data collected 5 years apart were obtained from a subset of Lao Loum subjects. APOE 4 allele frequencies were higher among minorities (31.3%) than among Lao Loum (12.6%). In Lao Loum, but not in minorities, mean waist circumference and blood pressure increased significantly across age groups. Comparisons of health conditions between the beginning and end of the 5-year period revealed significant increases in obesity and blood glucose levels in Lao Loum. APOE 4 carriers exhibited significant increases in resting heart rate in both ethnic groups.A higher 4 allele frequency was observed in Laotian minorities than in the Laotian majority. Furthermore, higher obesity, blood pressure and blood glucose were observed in the middle-aged ethnic majority. Therefore, given these genetic and non-communicable disease risk factors, it seems likely that as the Laotian population ages, elevated rates of non-communicable aging-related diseases, such as dementia, will also become more prevalent.
PubMed | Mahosot Hospital and Kansai Medical University
Type: Journal Article | Journal: The American journal of tropical medicine and hygiene | Year: 2016
We developed a combined conventional polymerase chain reaction (PCR) and real-time PCR (qPCR)-based assay for detecting and discriminating between Opisthorchis viverrini and Haplorchis taichui parasite infections. The first PCR amplifies the mitochondrial cytochrome c oxidase subunit I (COI) genes of parasites, and differential diagnosis is achieved by performing qPCR with specific primers and SYBR Green I. The detection limit of the assay was found to be 2.0 10
Katangwe T.,Queen Elizabeth Central Hospital |
Purcell J.,University of Malawi |
Bar-Zeev N.,Queen Elizabeth Central Hospital |
Bar-Zeev N.,University of Malawi |
And 12 more authors.
Emerging Infectious Diseases | Year: 2013
A case of human melioidosis caused by a novel sequence type of Burkholderia pseudomallei occurred in a child in Malawi, southern Africa. A literature review showed that human cases reported from the continent have been increasing.
Cheng A.C.,Monash University |
Currie B.J.,Charles Darwin University |
Dance D.A.B.,Mahosot Hospital |
Funnell S.G.P.,Public Health England |
And 3 more authors.
American Journal of Tropical Medicine and Hygiene | Year: 2013
Clinical definitions of melioidosis and inhalation-acquired melioidosis (Burkholderia pseudomallei infection) are described together with the evidence used to develop these definitions. Such definitions support accurate public health reporting, preparedness planning for deliberate B. pseudomallei release, design of experimental models, and categorization of naturally acquired melioidosis. Copyright © 2013 by The American Society of Tropical Medicine and Hygiene.
Salam A.P.,Guys And St Thomas National Health Service Trust |
Khan N.,Guys And St Thomas National Health Service Trust |
Malnick H.,Public Health England |
Kenna D.T.D.,Public Health England |
And 5 more authors.
Emerging Infectious Diseases | Year: 2011
We describe melioidosis associated with travel to Nigeria in a woman with diabetes, a major predisposing factor for this infection. With the prevalence of diabetes projected to increase dramatically in many developing countries, the global reach of melioidosis may expand.
News Article | September 7, 2016
LONDON (Reuters) - Scrub typhus, a deadly disease common in southeast Asia and spread by microscopic biting mites known as chiggers, has now taken hold in a part of South America and may have become endemic there, scientists said on Wednesday. The tropical disease, which kills at least 140,000 people a year in the Asia-Pacific region, has been confirmed in a cluster of cases on a large island off Chile, some 12,000 kilometres from its usual haunts on the other side of the Pacific. Scrub typhus has been known of for years and the bacteria that causes it was first identified in Japan in 1930. It is caused by the bacteria, Orientia tsutsugamushi, transmitted by chiggers, and spreads through the lymphatic fluid. Those infected find the illness can begin quite suddenly, with shaking chills, fever, severe headache, infection of the mucous membrane in the eyes, and lymph node swelling. Until 2006, scrub typhus was thought to be limited to an area called the "tsutsugamushi triangle", from Pakistan in the west to far eastern Russia in the east to northern Australia in the south. But writing in the New England Journal of Medicine, researchers from Britain's Oxford University and the Pontificia Universidad Católica and Universidad del Desarrollo in Chile the cases found off of Chile’s mainland "suggest there may be a much wider global distribution than previously understood." In 2006, two cases of scrub typhus were found outside the triangle. One, in the Middle East, was caused by a previously unrecorded bacteria related to tsutsugamushi and named Orientia Chuto. The second was found on Chiloé island, just off mainland Chile. In January 2015 and again in early 2016, three more cases were discovered in Ancud, on the northern coast of Chiloé. "Scrub typhus is a common disease but a neglected one," said Paul Newton, director of the Lao–Oxford–Mahosot Hospital Wellcome Trust Research Unit, which collaborated in the study. "Given that it is known to cause approximately a million clinical cases, and kills at least 140,000 people each year, this evidence of an even bigger burden of disease in another part of the world highlights the need for more research and attention to it."
Acestor N.,Foundation for Innovative New Diagnostics FIND |
Cooksey R.,University of Oxford |
Newton P.N.,University of Oxford |
Newton P.N.,Mahosot Hospital |
And 6 more authors.
PLoS ONE | Year: 2012
Background: An increasing use of point of care diagnostic tests that exclude malaria, coupled with a declining malaria burden in many endemic countries, is highlighting the lack of ability of many health systems to manage other causes of febrile disease. A lack of knowledge of distribution of these pathogens, and a lack of screening and point-of-care diagnostics to identify them, prevents effective management of these generally treatable contributors to disease burden. While prospective data collection is vital, an untapped body of knowledge already exists in the published health literature. Methods: Focusing on the Mekong region of Southeast Asia, published data from 1986 to 2011 was screened to for frequency of isolation of pathogens implicated in aetiology of non-malarial febrile illness. Eligibility criteria included English-language peer-reviewed studies recording major pathogens for which specific management is likely to be warranted. Of 1,252 identified papers, 146 met inclusion criteria and were analyzed and data mapped. Results: Data tended to be clustered around specific areas where research institutions operate, and where resources to conduct studies are greater. The most frequently reported pathogen was dengue virus (n = 70), followed by Orientia tsutsugamushi and Rickettsia species (scrub typhus/murine typhus/spotted fever group n = 58), Leptospira spp. (n = 35), Salmonella enterica serovar Typhi and Paratyphi (enteric fever n = 24), Burkholderia pseudomallei (melioidosis n = 14), and Japanese encephalitis virus (n = 18). Wide tracts with very little published data on aetiology of fever are apparent. Discussion and Conclusions: This mapping demonstrates a very heterogeneous distribution of information on the causes of fever in the Mekong countries. Further directed data collection to address gaps in the evidence-base, and expansion to a global database of pathogen distribution, is readily achievable, and would help define wider priorities for research and development to improve syndromic management of fever, prioritize diagnostic development, and guide empirical therapy. © 2012 Acestor et al.
Pathoumthong K.,Health Science University |
Khampanisong P.,Health Science University |
Quet F.,Institute Of La Francophonie Pour La Medecine Tropicale Ifmt |
Quet F.,Limoges University Hospital Center |
And 4 more authors.
Vaccine | Year: 2014
Health care workers (HCW) are a population at high risk of hepatitis B virus (HBV) infection, especially in endemic countries such as Lao PDR. Effective vaccines are available since over 10 years, but many HCWs are not aware of the risk of infection and are still not immunized against hepatitis B. This study aimed to assess immunization coverage against hepatitis B among the students of the University of Health Sciences (UHS) of Lao PDR in 2013 and to look for the causes of non-vaccination. A cross-sectional survey was conducted by self-administered questionnaire on a representative stratified sample of each academic year in each faculty. In total, 961 questionnaires were collected, Basic Sciences: 143, Medicine: 167, Pharmacy: 148, Dentistry: 139, Nursing Sciences: 159, Medical Technology: 99, and Postgraduate Studies: 106. Respondents were predominantly female (59.1%), mean age 25.1. ±. 7.0 years, single (76.3%), from the provinces (68.0%), of the Lao Loum ethnic group (84.4%). Among them, 21% were fully vaccinated against hepatitis B and 9.5% partially. Immunization coverage rates were significantly higher among women (p= 0.01), students aged over 25 years, married or belonging to the post-graduate faculty (p<. 0.001). The most common reason (38.6%) given for non-vaccination was not knowing where to get vaccinated. Knowledge about hepatitis B, scored from 0 to 5, was poor (0-1) for 86.5% of the students, but 77.5% were aware of the hepatitis B vaccine. The knowledge scores were significantly higher for students aged over 25 years, married or post-graduated (p<. 0.001). Vaccination coverage against hepatitis B is dramatically low among students of health professions in Laos, largely because of their lack of knowledge and awareness. Upon admission to the University, all future HCWs should receive information about the occupational risks of blood-borne viruses transmission and be encouraged to get vaccinated against hepatitis B. © 2014 Elsevier Ltd.