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Objectives Food composition data are key for many nutrition related activities in research, planning and policy. Combatting micronutrient malnutrition among women and young children using sustainable food based approaches, as aimed at in the SMILING project, requires high quality food composition data. Methods In order to develop capacity and to align procedures for establishing, updating and assessing the quality of key nutrient data in the food composition tables in Southeast Asia, a detailed roadmap was developed to identify and propose steps for this. This included a training workshop to build capacity in the field of food composition data, and alignment of procedures for selecting foods and nutrients to be included for quality assessment, and update of country specific food composition tables. The SEA partners in the SMILING project finalised a country specific food composition table (FCT) with updated compositional data on selected foods and nutrients considered key for designing nutrient dense and optimal diets for the target groups. Results Between 140 and 175 foods were selected for inclusion in the country specific FCTs. Key-nutrients were: energy, protein, total fat, carbohydrates, iron, zinc, (pro-)-vitamin A, folate, calcium, vitamin D, vitamin B1, vitamin B2, vitamin B3, vitamin B6, vitamin B12 and vitamin C. A detailed quality assessment on 13 key-foods per nutrient was performed using international guidelines. Nutrient data for specific local food items were often unavailable and data on folate, vitamin B12 and vitamin B6 contents were mostly missing. For many foods, documentation was not available, thereby complicating an in-depth quality assessment. Despite these limitations, the SMILING project offered a unique opportunity to increase awareness of the importance of high quality well documented food composition data. Conclusion for Practise The self-reported data quality demonstrated that there is considerable room for improvement of the nutrient data quality in some countries. In addition, investment in sustainable capacity development and an urgent need to produce and document high quality data on the micronutrient composition of especially local foods is required., Author(s): Paul Hulshof [sup.1] , Esmee Doets [sup.2] , Sok Seyha [sup.3] , Touch Bunthang [sup.3] , Manithong Vonglokham [sup.4] , Sengchanh Kounnavong [sup.4] , Umi Famida [sup.5] , Siti [...]

Background This study investigated alcohol consumption prevalence among adolescents in school settings in Lao People's Democratic Republic and identified factors associated with alcohol consumption to establish better school-based interventions. Methods Self-administered questionnaires containing items assessing alcohol drinking behaviour and underlying factors were administered to 393 secondary school students ages 10–19 y. Multivariate logistic regression was used to predict factors associated with drinking behaviour. Results Fifty-eight percent of respondents reported ever drinking alcohol. Among the drinkers, 52.6% were light drinkers, 16.8% were moderate drinkers, 27.0% were heavy drinkers and 3.5% were very heavy drinkers. Older age group (adjusted odds ratio [AOR] 5.2 [95% confidence interval {CI} 2.6 to 10.1]); peer pressure, particularly when more than two-thirds of friends drank alcohol (AOR 8.0 [95% CI 2.2 to 29.5]); and siblings' drinking behaviour (AOR 2.8 [95% CI 1.4 to 5.5]) were positively associated with alcohol use, while no permission to drink at home (AOR 0.2 [95% CI 0.1 to 0.6]), uncertain of permission to drink at home (AOR 0.06 [95% CI 0.02 to 0.1]) and never attempting to buy alcohol (AOR 0.2 [95% CI 0.1 to 0.4]) were negatively associated with respondents' alcohol use. Conclusions By the age of 19 y, most participating students had started drinking alcohol. One-third of them were permitted to drink by family members and drinking was strongly accelerated by peer pressure. Educational programmes are needed for adolescents attending school and their families that employ peer learning to raise awareness of the ill effects of alcohol use. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine sociodemographic and health correlates of concurrent binge drinking and tobacco use in a national adult population in Laos. A cross-sectional study based on a stratified cluster random sampling was conducted in 2013. The total sample included 2,543 individuals 18-64 years. Questionnaire interview, blood pressure, and anthropometric measurements, and biochemistry tests were conducted. Results indicate that 18.6% (38.3% in men and 5.2% in women) of the participants had engaged in concurrent current tobacco use and past month binge drinking, 15.2% in current tobacco use only and 28.4% in past month binge drinking only. Among current tobacco users, 42.2% engaged in frequent heavy drinking (3 or more times/month), and among past month heavy alcohol users, 55.8% were daily current tobacco users. In adjusted analysis, being 35 to 49 years old, lower education, having normal weight, and moderate or high physical activity were associated with concurrent current tobacco use and past month heavy drinking. Current tobacco use alone increased with age and decreased with education and heavy drinking alone decreased with age and increased with education. Findings suggest sociodemographic and health factors are important for public health interventions in addressing concurrent tobacco and alcohol use. [ABSTRACT FROM AUTHOR]

Objective: Diabetes is a major and fast-growing public health problem in Southeast Asia. We determined the prevalence of pre-diabetes and diabetes and assessed the levels of awareness, treatment and control in Lao People's Democratic Republic (PDR).Methods: A national cross-sectional study based on a stratified cluster random sampling was conducted in 2013. The sample comprised 2492 individuals aged 18-64 years (59.3% females; mean age 38.7 years, SD = 12.8) from Lao PDR. We followed the WHO STEPS method: step 1, questionnaire interview; step 2, anthropometric and Blood Pressure (BP) measurements; and step 3, biochemistry tests. Multinominal logistic regression was used to investigate the determinants of pre-diabetes and diabetes (fasting plasma glucose levels ≥ 7.0 mmol/L; or using insulin or oral hypoglycaemic drugs; or having a history of diagnosis of diabetes).Results: 5.7% of the population had diabetes, 4.7% of men and 6.4% of women, and 2.3% had pre-diabetes, 1.8% of men and 2.6% of women. Only 14.1% of the population sample indicated that they had ever their blood glucose measured by a health-care worker. This was higher in urban (20.9%) than rural (10.9%) dwellers (P < 0.001), and among female (16.6%) than male (10.5%) participants (P < 0.001). Among those with diabetes, 58.1% were aware of their diabetes status, 40.3% were taking treatment and 10.9% had controlled diabetes. The factor independently associated with impaired fasting glycaemia (IFG) or pre-diabetes was central obesity (Adjusted Relative Risk Ratio-ARRR: 3.92, Confidence Interval-CI: 1.89, 8.14) but none of the other health (general body weight, fruit and vegetable consumption, physical activity, substance use, hypertension and cholesterol) and sociodemographic (age, sex, education, employment status, marital status, ethno-linguistic group and residence status) variables. Factors independently associated with diabetes were older age (ARRR: 5.12, CI: 1.55, 10.20), central obesity (ARRR: 2.15, CI: 1.16, 4.00), low or moderate physical activity (ARRR: 0.75, CI: 0.60, 0.93), having hypertension (ARRR: 1.68, CI: 1.01, 2.83), and dyslipidaemia (ARRR: 1.75, CI: 1.08, 2.81).Conclusion: A public health response is needed in the form of integrated and comprehensive action targeting major non-communicable diseases in the country. [ABSTRACT FROM AUTHOR]

Objectives Micronutrient deficiencies, in southeast Asia (SE Asia), remain a public health challenge. We evaluated whether promoting the consumption of locally available nutritious foods, which is a low-risk micronutrient intervention, alone can ensure dietary adequacy, for women of reproductive age and 6-23 m old children. Methods Representative dietary data from Cambodia, Indonesia, Lao PDR, Thailand and Vietnam were analysed using linear programming analysis to identify nutrients that are likely low in personal food environments (problem nutrients), and to formulate food-based recommendations (FBRs) for three to six target populations per country. Results The number of problem nutrients ranged from zero for 12-23 m olds in Indonesia, Thailand and Vietnam to six for pregnant women in Cambodia. The FBRs selected for each target population, if adopted, would ensure a low percentage of the population was at risk of inadequate intakes for five to ten micronutrients, depending on the country and target population. Of the 11 micronutrients modelled, requirements for iron, calcium and folate were most difficult to meet (≥ 10 of the 24 target populations), using FBRs alone. The number of individual FBRs selected per set, for each target population, ranged from three to eight; and often included meat, fish or eggs, liver/organ meats, vegetables and fruits. Conclusions for practice Intervention strategies need to increase access to nutritious foods, including products fortified with micronutrients, in SE Asia, when aiming to ensure dietary adequacy for most individuals in the population. [ABSTRACT FROM AUTHOR]

Background: The Lao People's Democratic Republic is facing a critical shortage and maldistribution of health workers. Strengthening of the health workforce has been adopted as one of the five priorities of the National Health Sector Strategy (2013-2025). This study aims to identify, explore, and better understand the key challenges for strengthening the Laotian health workforce. Methods: This study applied exploratory and descriptive qualitative methods and adapted a working life-span framework. Twenty-three key stakeholders with particular insights into the current situation of the health workforce were purposively recruited for in-depth interviews. Important policy documents were also collected from key informants during the interviews. Thematic analysis was employed for the textual data using MAXQDA 10. Results: The overarching problem is that there is a perceived severe shortage of skilled health workers (doctors, nurses, and midwives) and lab technicians, especially in primary health facilities and rural areas. Key informants also identified five problems: insufficient production of health workers both in quantity and quality, a limited national budget to recruit enough health staff and provide sufficient and equitable salaries and incentives, limited management capacity, poor recruitment for work in rural areas, and lack of well-designed continuing education programs for professional development. These problems are interrelated, both in how the issues arise and in the effect they have on one another. Conclusions: To improve the distribution of health workers in rural areas, strategies for increasing production and strengthening retention should be well integrated for better effectiveness. It is also essential to take the Laotian-specific context into consideration during intervention development and implementation. Furthermore, the government should acknowledge the inadequate health management capacity and invest to improve human resource management capacity at all levels. Finally, assessment of interventions for health workforce strengthening should be developed as early as possible to learn from the experiences and lessons in the Lao People's Democratic Republic. [ABSTRACT FROM AUTHOR]

This study aimed to determine the potential predictive value of four noninvasive anthropometric indices in screening for the risk of diabetes and hypertension in the Lao population. The data used for this study were collected as part of the National Health Survey which used the World Health Organization's stepwise approach, covered 17 provinces and Vientiane capital, and had a representative sample of 3240 participants above 18 years old. Among the anthropometry indices tested, waist-to-height ratio (WHtR) had the highest predictive power for the prevalence of diabetes (area under the curve [AUC] = 0.73) and hypertension (AUC = 0.70). It is suitable for use in urban or rural areas and for fieldwork. The WHtR can serve as a public health and clinical screening tool, as there are no differences between sexes, ages, and ethnicities when monitoring diabetes and hypertension risk in Lao PDR, using the optimal cutoff point of 0.5 for both diabetes and hypertension., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The study aimed to assess the prevalence and correlates of fruit and vegetable (FAV) consumption and its associations with noncommunicable diseases risk factors among adults in Laos. In a national cross-sectional survey in 2013, 2527 individuals (18-64 years old) responded to a questionnaire, and anthropometric and blood pressure measurements, and biochemistry tests were conducted. On average, participants had 0.99 servings of fruits a day and 1.33 servings of vegetables a day, a combined total of 2.32 servings of FAVs per day. Almost 1 in 5 respondents (18.9%) had 2 or more servings of fruit a day, 8.7% had 3 or more servings of vegetables a day, and 94.7% had less than 5 servings of FAV a day. In adjusted logistic analysis, being a Lao-Tai increased the odds of consuming 2 or more servings of fruits daily. Past month binge drinking decreased the odds of having 3 or more servings of vegetables daily. Higher education and urban residence decreased the odds of inadequate (<5 servings) FAV consumption. In adjusted linear regression analysis, increased FAV consumption was associated with higher body mass index scores. A high prevalence of inadequate FAV consumption was found. Interventions targeting identified modifiable risk factors, including lower education, general obesity, and binge drinking, may potentially increase FAV consumption in Laos.