Search

Background: Universal health coverage is target 3.8 of the Sustainable Development Goals. In many lower-middle-income countries, however, major coverage gaps exist. Those who do receive services often experience high out-of-pocket expenses. To achieve universal health coverage, Lao PDR, a lower-middle-income country in South-East Asia, is shifting from a fragmented model of health financing to a national health insurance scheme. Objective: The objective of this cross-sectional survey was to assess the knowledge of the NHI in Lao PDR among insured in- and out-patients using health services at selected public health facilities at provincial, district and health centre level in six provinces. Methods: This was a cross-sectional survey. Healthcare facilities were selected based on the rate of use of health services at the health facility and participants selected using systematic random sampling. Exit interviews were conducted with in- and out-patients of each selected health facility, using a pre-tested structured questionnaire. Descriptive statistics were generated including means (median), frequency and percentages. Poisson regression was applied to determine the factors associated with knowledge of the insurance scheme. Results: In total 326 participants were recruited (response rate 93%). Of these, less than two-thirds (62.3%) said they had their eligibility documents with them. Only 23.6% knew the co-payment fee at the health centre level; while 18.1% and 18.7% knew about the co-payment fee at the district and provincial healthcare level, respectively. A key determinant of accessing NHI and health services was knowledge of the scheme and its benefits. Conclusion: This study suggests in Lao PDR, awareness about health insurance is low. More innovative demand-side strategies are needed to create awareness and understanding of the NHI and its benefits. Without an understanding of what insurance policies mean, universal health coverage cannot be achieved, even where appropriate and acceptable services are accessible. [ABSTRACT FROM AUTHOR]

Background: Adolescents are at high risk of unintended pregnancy and consequent unsafe abortion. Evidence from Lao PDR suggests a high but underreported prevalence of induced abortion, especially amongst adolescents. Research suggests adolescents are less likely to have an unsafe abortion when they have accurate knowledge about abortion and hold positive attitudes towards abortion. Objective: The purpose of this study was to investigate awareness and attitudes towards abortion and associated factors in Lao PDR. Methods: This study used a descriptive, cross-sectional design. The study was conducted between January and May 2019 in two different provinces within Lao PDR, namely, Khammouane and Champasack provinces. Participants included in- and out-of-school male and female adolescents (n = 800). Data were collected using a structured questionnaire and entered into the EPI Data version 3.1. All analysis was undertaken using STATA v.13. Univariate analysis and frequency distributions were used to study the pattern of responses and bivariate descriptive analysis to report attitudes and knowledge by participant characteristics. The association between participant characteristics and overall scores of attitudes towards abortion was evaluated using multiple logistic regression. Findings: Most respondents (78.8%) were aware of the processes and potential consequences of becoming pregnant at a young age. One-third of respondents (31.5%), were aware of induced abortion. Of those, only 12.1% held positive attitudes towards induced abortion. Factors associated with positive attitudes towards abortion were ethnicity, mother's education and ever having had sex. Conclusion: In the case of unintended or unwanted pregnancy, adolescents must also have adequate knowledge and access to safe abortion and associated counselling services. This study suggests a need to increase sexual and reproductive health literacy including information about safe abortion. This requires a holistic approach to sexual education and needs the support and involvement of adolescents themselves as well as parents, community members and healthcare workers. [ABSTRACT FROM AUTHOR]

Background: Adolescents are particularly vulnerable to poor sexual and reproductive health outcomes. In addition, Lao PDR has the highest teenage pregnancy rate in southeast Asia and a high maternal mortality ratio. Objective: This study aimed to provide a comprehensive exploration of factors that influence SRH knowledge, attitudes, and practices of adolescents in Bokeo Province, Lao PDR. Method: Data from the Adolescent Girl Situation Analysis cross-sectional study, collected in 2018 using a mixed-method approach with 837 adolescents aged 10--19, and key informant interviews, were analysed. Regression analyses were used to identify predictors of modern contraception knowledge, autonomy, gender-based violence, sexual activity, and contraception use. This was complemented with qualitative thematic content analysis. Results: Adolescents living in two rural districts had lower sexual and reproductive health knowledge compared to urban district residents. Findings showed misconceptions about the birth control pill, a belief that sex education is important, but that the current teaching quality is problematic. There was a strong positive association between knowledge and autonomy. In the two rural districts, residents were more likely to lack autonomy. Marriage was described as an autonomous decision, yet 40.4% lacked autonomy regarding marriage. Among sexually active adolescents, 35.2% used contraception. Boys and girls were said to be equal, yet education access and gender roles favoured boys. Additionally, violence was more justified by husbands against their wives. Conclusion: The study helps to understand the views and perceptions of adolescents and key informants on gender equality and gender-based violence. Three main areas require more effort and greater investment to improve adolescent sexual and reproductive health: knowledge and use of contraceptives, gender inequality, and autonomy. There is poor knowledge of contraceptive methods, indicating a need to further integrate comprehensive sexual education, introduced in primary school, and to increase investment in training and monitoring teachers. [ABSTRACT FROM AUTHOR]

Background: In Lao PDR, 15% of the married women want to postpone or prevent having a child, yet most are not using contraceptives to achieve this. Literature shows that usage of contraceptives is strongly dependent on the quality of family planning services. However, little is known about the quality of family planning services in Lao PDR. Objective: To assess the quality of family planning services provided in public health facilities in Lao PDR. Methods: Using a cross-sectional study design, public health facilities in three provinces in Lao PDR were assessed on structure, process and outcome measures of quality. Following the Quick Investigation of Quality approach, client exit interviews (n = 393), structured observations (n = 218) and facility audits (n = 17) were conducted. Results: Facility audits, observations and client exit interviews painted different pictures of the overall quality of family planning services. Taking all together, the quality was rated as moderate to high. Only marginal differences in quality were found between family planning services located in different geographical areas. Notably, only married women with children were using these services. Although contraceptives were provided, little attention was given to the information provided during consultations and to the interpersonal relationship between client and provider. Conclusion: The results suggest that although improvements are needed to enhance quality of individual consultations, the greatest gain in reducing unwanted pregnancies would be made by ensuring access for all women of reproductive age. [ABSTRACT FROM AUTHOR]

Background: The transition from childhood to adolescence is a critical transitional period for girls, and as they experience these changes, having knowledge of, and being able to practice, good menstruation hygiene management is crucial. The objective of this study was to understand in and out of school adolescents' menstrual hygiene management practice, sources of information and attitudes towards menstruation. Methods: A cross sectional, descriptive study was conducted between November 2018 and May 2019. The sampling included adolescent girls aged 11--19 years in higher secondary schools in Khammouane and Champassak provinces and out-of-school adolescent girls. Out of the total number of 433 participants enrolled in the study, only 343 girls had reached menarche and were included in the study. Factors associated with menstruation hygiene management practice were examined with bivariate and multivariate analyses. Results: Out of 343 subjects who had reached menarche, 44% reported good menstrual hygiene management practice. Over half of the participants, however, were unable to access the tools of good menstruation hygiene management practice, including having somewhere to dispose of used sanitary pads in private. Being older (16--19 years) (AOR:2.4; 95%CI 1.4 to 3.9), and having primary education (AOR 0.4; 95%CI 0.2 to 0.9) were associated with good practice as was fathers' level of education (AOR 2.1; 95%CI 1.0 to 4.1) and mother-girl discussion about menstruation (AOR 2.2; 95%CI 1.0 to 5.0). No significant differences were found between in- and out-of-school adolescents. Conclusions: In this study, not all participants were able to practice optimal menstruation hygiene management. This is important as good menstrual hygiene management is associated with better health and being able to participate fully in education and work. Further education is needed, but it is also important to ensure that all adolescent girls have access to the necessary tools for effective menstruation hygiene management. [ABSTRACT FROM AUTHOR]

Background: Lao PDR has identified the need to target adolescent public health concerns. Adolescents suffering from poor health and nutrition during rapid growth and development may be at risk of anaemia due to high iron requirements and the rapid depletion of body iron stores. Objective: This study assessed the prevalence and severity of anaemia among school adolescents in Pholhong district, Vientiane province, Lao PDR. Methods: A school-based cross-sectional study was conducted among 405 randomly selected school adolescents across 8 high schools in a rural district of Vientiane province. Adolescents aged 10--18, both male and female, were recruited. Haemoglobin concentration from capillary blood was measured. Descriptive statistics were computed for prevalence of anaemia, anthro-pometric measurements, socio-economic and socio-demographic variables. Multivariate logistic regression analysis was performed to identify determinants of anaemia among subjects. Results were expressed as odds ratios and 95% confidence intervals. Results: The prevalence of anaemia among adolescents in the study area was 19.4%. There was no difference in the prevalence of anaemia between younger and older adolescents, but the prevalence of anaemia was higher in female adolescents than among males (crude OR = 3.91, 95% CI 2.20 to 6.96). On univariate analysis, coming from an ethnic minority household was found to be significantly associated with anaemia among these adolescents (p < 0.05). After adjusting for other variables, only the effect of sex remained significant. Other factors showing no significant association with anaemia included parents' employment status, family size, and living conditions. Conclusions: The prevalence of anaemia in this population is of public health concern with adolescents of both sexes at risk of developing anaemia. The national nutrition programme to control and manage anaemia by distributing a weekly iron and folate supplement for adolescent girls together with a deworming programme twice per year appears to have partly successful but could be strengthened. [ABSTRACT FROM AUTHOR]

Background The transition between hospital and home is a vulnerable period for acutely hospitalized older patients during which they are at increased risk for adverse health outcomes. Yet, studies describing experiences of a geriatric patient population postdischarge from a patient perspective are missing. Objective To characterize patient experiences with recovering at home after acute hospitalization. Design and Methods Qualitative semi-structured interviews, involving 20 recently discharged patients (age ≥ 70), were conducted. A thematic analysis of the content was performed. Results Ten categories were identified as recurring topics, which were grouped into 3 major themes. The first theme describes the effect of hospitalization on daily life. Participants described that the problems they encountered were mostly caused by symptoms they experienced since discharge, which were grouped into 2 themes: (a) physical consequences of hospitalization and (b) motivational and psychological problems after hospitalization. Among most frequently presented symptoms were fatigue, apathy, unsteadiness while standing, and fear of falling. Implications Impairment in mobility and instrumental activities of daily living was the dominant experience for interviewed patients. This disability was mainly attributed to four main symptoms: fatigue, apathy, unsteadiness while standing, and fear of falling. We propose a tentative model that summarizes the role of posthospital symptoms in the recovery process and the potential syndromes (frailty, posthospital syndrome, palliative symptoms, and sickness behavior) that could underlie these shared symptoms which may act as a conceptual framework for future research. Our study points at the relevance of symptom experiences in functional recovery postdischarge. [ABSTRACT FROM AUTHOR]

Background: The transition between hospital and home is a vulnerable period for acutely hospitalized older patients during which they are at increased risk for adverse health outcomes. Yet, studies describing experiences of a geriatric patient population postdischarge from a patient perspective are missing., Objective: To characterize patient experiences with recovering at home after acute hospitalization., Design and Methods: Qualitative semi-structured interviews, involving 20 recently discharged patients (age ≥ 70), were conducted. A thematic analysis of the content was performed., Results: Ten categories were identified as recurring topics, which were grouped into 3 major themes. The first theme describes the effect of hospitalization on daily life. Participants described that the problems they encountered were mostly caused by symptoms they experienced since discharge, which were grouped into 2 themes: (a) physical consequences of hospitalization and (b) motivational and psychological problems after hospitalization. Among most frequently presented symptoms were fatigue, apathy, unsteadiness while standing, and fear of falling., Implications: Impairment in mobility and instrumental activities of daily living was the dominant experience for interviewed patients. This disability was mainly attributed to four main symptoms: fatigue, apathy, unsteadiness while standing, and fear of falling. We propose a tentative model that summarizes the role of posthospital symptoms in the recovery process and the potential syndromes (frailty, posthospital syndrome, palliative symptoms, and sickness behavior) that could underlie these shared symptoms which may act as a conceptual framework for future research. Our study points at the relevance of symptom experiences in functional recovery postdischarge., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)