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Thalassemia is a major public health and economical burden in Lao People's Democratic Republic (Lao PDR). This study is aiming to elaborate the current situation of Thalassemia in Laos. α- and β-thalassemia (α- and β-thal) includes the common Hb S (

Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have important effects on population health. In this study, we used an interrupted time series design to assess the immediate effect of the pandemic on 31 health services in two low-income (Ethiopia and Haiti), six middle-income (Ghana, Lao People’s Democratic Republic, Mexico, Nepal, South Africa and Thailand) and high-income (Chile and South Korea) countries. Despite efforts to maintain health services, disruptions of varying magnitude and duration were found in every country, with no clear patterns by country income group or pandemic intensity. Disruptions in health services often preceded COVID-19 waves. Cancer screenings, TB screening and detection and HIV testing were most affected (26–96% declines). Total outpatient visits declined by 9–40% at national levels and remained lower than predicted by the end of 2020. Maternal health services were disrupted in approximately half of the countries, with declines ranging from 5% to 33%. Child vaccinations were disrupted for shorter periods, but we estimate that catch-up campaigns might not have reached all children missed. By contrast, provision of antiretrovirals for HIV was not affected. By the end of 2020, substantial disruptions remained in half of the countries. Preliminary data for 2021 indicate that disruptions likely persisted. Although a portion of the declines observed might result from decreased needs during lockdowns (from fewer infectious illnesses or injuries), a larger share likely reflects a shortfall of health system resilience. Countries must plan to compensate for missed healthcare during the current pandemic and invest in strategies for better health system resilience for future emergencies.

CONTEXT The Greater Mekong Subregion has been undergoing rapid agricultural transformation over the last decades, as traditional diverse subsistence-oriented agriculture is evolving towards intensified commercial production systems. Negative environmental impacts often include deforestation, nutrient pollution, and greenhouse gas (GHG) emissions. OBJECTIVE This study aims to explore the potential of crop-livestock integration to mitigate trade-offs between economic and environmental impacts of smallholder farming systems at different stages of agricultural transition and degrees of agricultural diversity across the Greater Mekong Subregion. METHODS We chose a ‘middle ground’ between detailed modeling of few, representative farming systems and modeling of large household populations. 24 low and high diversity farms were selected in Laos (Xieng Khouang province), Cambodia (Ratanakiri province) and Vietnam (Central Highlands) from a survey dataset of 1300 households. These farming systems were simulated with the whole-farm bio-economic and multi-objective optimization model FarmDESIGN, calculating operating profit, GHG emissions and nitrogen (N) balance. Two optimizations (‘business as usual’ vs. ‘crop-livestock integration’) were performed, generating ‘solution spaces’ or alternative configurations aiming to maximize profitability, keep farm N balanced and minimize GHG emissions. RESULTS AND CONCLUSIONS Agricultural systems across the sites differed in their production orientation and management practices, representing various stages of agricultural transition. Nitrogen balances varied between sites, being negative in Ratanakiri (average − 20.5 kg N ha−1 y−1) and Xieng Khouang (−36.5 kg N ha−1 y−1) and positive in the Central Highlands (73 kg N ha−1 y−1). Negative balances point to unsustainable mining of nutrients due to sale of cash crops without sufficient inputs, and positive balances to the risk of environmental contamination. Total GHG emissions ranged from 0.52–8.12 t CO2e ha−1 and were not significantly impacted by stage of agricultural transformation or agricultural diversity. GHG sources in Ratanakiri and Xieng Khouang were determined by crop residue burning while in Central Highlands fertilizer and livestock were main emitters. High diversity farms obtained higher operating profits (10,379 USD y−1) than low diversity farms (4584 USD y−1). Crop-livestock integration, a combination of measures including introduction of improved forages grasses, manure recycling and residue feeding, and reduction of residue burning, resulted in larger ‘solution spaces’, thus providing farmers with more options to mitigate agro-environmental trade-offs. SIGNIFICANCE These findings underline the potential of crop-livestock integration to support sustainable intensification pathways in the Greater Mekong region. Public and private investment in further research and extension is needed to develop and scal, Agricultural Systems, 195, ISSN:0308-521X

In Lao People’s Democratic Republic (Lao PDR), information on school sanitation and menstrual health among secondary school girls is limited. This study aimed to explore knowledge and practices surrounding menstrual health and to identify factors associated with school absence due to menstruation among secondary school girls in Lao PDR. The study involved 1,366 girls from grade 9 to grade 12 in six secondary schools in Luang Prabang Province. Data on socio-demographics and menstrual health of the girls and data on school toilets was collected. Logistic regression analysis was performed to identify the factors associated with school absence due to menstruation. The mean age was 15.8 years old. The average age of menarche was 12.9 years old. Of 1,366 girls, 64.6% were shocked or ashamed when they reached menarche and 31.8% had been absent from school due to menstruation in the six months before this study was conducted. Factors associated with school absence due to menstruation were age ≥ 16 years old (AOR = 1.79, 95% CI 1.37–2.34), higher income (AOR = 2.38, 95% CI 1.16–4.87), menstrual anxiety (AOR = 1.55, 95% CI 1.09–2.20), using painkillers (AOR = 4.79, 95% CI 2.96–7.76) and other methods (AOR = 2.82, 95% CI 1.86–4.28) for dysmenorrhea, and disposing used pads in places other than the school’s waste bins (AOR = 1.34, 95% CI 1.03–1.75). Living with relatives (AOR = 0.64, 95% CI 0.43–0.95) and schools outside the city (AOR = 0.59, 95% CI 0.38–0.90) were significantly less associated with school absence. Although the association between school toilets and school absence was not examined, the results of this study suggest that school toilets should be gender-separated and equipped with waste bins in the toilet. Furthermore, menstrual education should start at elementary schools and teacher training on menstrual health should be promoted.