Pharmaceutical regulation in context: the case of Lao People's Democratic Republic.
An explosive development of private pharmacies in the Lao People's Democratic Republic (Lao P.D.R.) has led to 80% of pharmaceuticals being provided by the private sector. In order to achieve the goal of access to good quality health care for all citizens, the Lao government is making an effort to regulate the private pharmaceutical sector using the emerging legal system of laws, decrees, and regulations. The aim of this paper is to describe and analyze the system of drug regulation in Lao P.D.R. in relation to the public social goals. Relevant official documents at the central, provincial and district levels have been reviewed, interviews were held with 30 key informants and 15 pharmacies were surveyed. The public social goals have been expressed in terms of equity and quality of care. However, total drug expenditure may be as low as US$1 per person per year which is far below any minimum standard and does not make it possible to achieve reasonable access to drugs for all. The regulatory system has so far been focused on entry into the pharmaceutical retail market and dealing with basic issues of product quality and conditions of sale. An enforcement system including sanctions is being developed; other policy instruments such as information and economic means are hardly being used at all. The government presently faces a trade-off between quality of pharmaceutical services and geographical equity of access. The study shows that regulation is strongly influenced by the general socioeconomic context. (+info)
Malaria prevalence and a brief entomological survey in a village surrounded by rice fields in Khammouan province, Lao PDR.
We surveyed Nongceng, a village in a south-eastern province of Lao PDR, for malaria and its vectors. Nongceng is situated in a basin and surrounded by rice fields. In February 1998 (dry season), 28.6% of 126 villagers were infected with malaria, and in September 1998 (rainy season), 16.3% of 147 villagers. The prevalence of malaria infection was consistently high in children under 10, and the predominant malaria species was Plasmodium falciparum. In brief surveys of the mosquitoes performed on the same day as the malaria surveys, 2007 Anopheles females from 12 species were collected by means of human bait, animal bait and resting collections. Of the vector species known to be important in transmitting malaria in neighbouring Thailand - An. minimus, An. dirus, and An. maculatus groups - only An. minimus was found. Its density was, however, very low in both seasons and it was therefore unlikely to be the vector. In fact, An. nivipes accounted for more than 65% of all mosquitoes collected and was the most common species collected from human baits. The results of this study show that endemic areas of malaria in Lao PDR are not necessarily related to forest. Rather, An. nivipes is suspected to be the most important vector. (+info)
Melioidosis and Pandora's box in the Lao People's Democratic Republic.
Melioidosis has not been recognized previously in Laos, but within months of starting a prospective study of community acquired septicemia in Vientiane, 2 patients with melioidosis were identified. One was a previously healthy, 44-year-old female rice farmer who presented with supraclavicular lymphadenitis and the other was a 74-year-old man with diabetes and renal calculi who was receiving corticosteroids and had septicemia and septic arthritis. (+info)
Plasmodium falciparum malaria in Laos: chloroquine treatment outcome and predictive value of molecular markers.
A 28-day treatment trial was undertaken, to determine the efficacy of chloroquine in Laos and to assess the predictive value of molecular markers (cg2, pfmdr1, and pfcrt) that were previously linked to chloroquine resistance. In total, 522 febrile patients were screened for falciparum malaria by rapid diagnostic assays. Of 81 patients (15.5% prevalence) who were positive by the assays and microscopy, 48 were eligible to participate in the 28-day trial. Nine patients defaulted. Chloroquine cured 54% (95% confidence interval, 45.8-61.8) of falciparum-infected patients. Of 18 (46%) patients with treatment failure, 13 (72%) experienced high-grade resistance. Polymorphisms in cg2 and the N86Y mutation in PfMDR1 were not predictive of treatment outcome. A mutation in PfCRT (K76T) was perfectly associated with in vivo chloroquine resistance. However, K76T was also present in in vivo-sensitive isolates, which suggests that the presence of this mutation was necessary, but not sufficient, to predict in vivo outcome in this cohort. (+info)
Revolving drug funds at front-line health facilities in Vientiane, Lao PDR.
Pharmaceutical cost recovery programmes, which have been mainly implemented in Africa, are gradually spreading to Southeast Asian countries that formerly belonged to the socialist bloc. This report describes the economic and operational realities of revolving drug funds (RDFs) at district hospitals and health centres in the capital of the Lao PDR by reviewing research conducted by the implementing department. People in the municipality spent an average of US$11 on drugs in 1996. The RDFs comprised only 3% of the total yearly drug sales in the municipality, whereas private pharmacies accounted for 75%. The RDFs were forced to operate in conjunction with the remaining government drug endowment and the thriving private pharmacies. This scheme has provided a stable supply of essential drugs. The assurance of drug availability at the front-line health facilities has resulted in increased utilization of the facilities despite the introduction of a drug fee. The cost recovery rate was 107% at health centres and 108% at district hospitals in two monitored districts during the 10 months from November 1997. Decentralized financial management was essential for cost recovery, allowing timely adjustment of selling prices as purchase prices rapidly inflated after the Asian economic crisis. The health staff observed that the people perceived drugs as everyday commodities that they should buy and take based on self-diagnosis and personal preference. Adaptation of the public health authorities to market-oriented thinking along with the establishment of pharmaceutical cost recovery occurred with few problems. However, both financial and operational management capacity at the municipal level pose a major challenge to policy clarification and scheme setting, especially in procurement, control of prescribing practices and the integration of drug dispensing with other components of quality clinical care. (+info)
A field study on malaria prevalence in southeastern Laos by polymerase chain reaction assay.
A detection survey for malaria infection by routine microscopy and polymerase chain reaction (PCR) assay was conducted on 336 inhabitants of two villages in Khammouane Province, Lao People's Democratic Republic (Lao PDR), in July 1997. Malaria infection was demonstrated in 58 (17.3%) subjects by microscopy and in 117 (34.8%) by PCR assay. Specimens positive by both methods were frequent in young villagers, suggesting the presence of many subclinical infections in older persons. The most common species of malaria parasite was Plasmodium falciparum (82.9%). Polymerase chain reaction assay detected mixed infections with 2-4 species in 27 specimens (23.1%). The results demonstrate that there are many subclinical malaria infections with low parasite level and infection with all four human malaria species in Lao PDR. (+info)
Measles epidemiology and outbreak investigation using IgM test in Laos.
Following the Pan American Health Organization (PAHO) recommendation on measles elimination, the Western Pacific Region of WHO (WPR) is emphasizing accelerated measles control programme especially since the achievement of polio eradication in WPR in 2000. This includes upgraded surveillance and mass measles vaccination campaign for children aged 9 months to 4 years. However, there are limited scientific evidences supporting the feasibility of this programme in Laos. To examine measles elimination feasibility in the country, we conducted measles outbreak investigation using immunoglobulin M (IgM). From March 1999 to March 2000, we conducted 7 outbreak investigations. At the outbreak sites, we examined clinical manifestations of cases and collected individual data. About five blood samples were drawn from each outbreak, and IgM antibodies to measles were tested. Of 7 investigated outbreaks, 5 were confirmed as measles, one was chickenpox, and one occurred in the inaccessible area due to flooding. In a village of high land Lao, blood drawn was refused. Of 185 cases, 64 (34.6%) cases were immunized, and 110 (59.5%) were unimunized. The estimated vaccine efficacy is 67.9%. The number of measles cases among school-aged children was 74 (40.0%), which represented 2.5% of the total population in investigated villages. Our findings showed various difficulties of the surveillance and the limited outcomes of mass measles vaccination campaign under the accelerated measles control programme by WPR. Efforts to improve cold chain as well as increasing routine immunization coverage must be the priority of measles control. (+info)
Impact of targeted programs on health systems: a case study of the polio eradication initiative.
The results of 2 large field studies on the impact of the polio eradication initiative on health systems and 3 supplementary reports were presented at a December 1999 meeting convened by the World Health Organization. All of these studies concluded that positive synergies exist between polio eradication and health systems but that these synergies have not been vigorously exploited. The eradication of polio has probably improved health systems worldwide by broadening distribution of vitamin A supplements, improving cooperation among enterovirus laboratories, and facilitating linkages between health workers and their communities. The results of these studies also show that eliminating polio did not cause a diminution of funding for immunization against other illnesses. Relatively little is known about the opportunity costs of polio eradication. Improved planning in disease eradication initiatives can minimize disruptions in the delivery of other services. Future initiatives should include indicators and baseline data for monitoring effects on health systems development. (+info)