Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU)

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1 Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU)

2 Began autumn 1999 at the Microbiology Laboratory, Mahosot Hospital, linked to Mahidol Oxford Research Unit (MORU), Bangkok Funded primarily by Wellcome Trust, founded by the will of Sir Henry Wellcome in 1936, via the University of Oxford 24 GoL staff and 33 project staff 93% Lao 3 Oxford employees 3 Administration 1 IRD virologist 1 Thai biologist 1 PHE Registrar 1 IT Manager & 6 staff 4 Goats

3 Lao PDR Land area ~ that of UK GDP ~ 450$/year 67 % rice farmers Infant mortality ~ 8 % Opened up in early 1990 s preceded by 200 years of war and colonisation Health policy has had to be decided in a Lao information vacuum In 1999 only infectious disease with an accessible diagnostic service malaria

4 Aims To conduct clinical tropical medicine research that will influence patient management and health policy in Laos & elsewhere What is the geographical epidemiology of fevers in Laos? What are the optimum & accessible diagnostic techniques? What is the optimum treatment of malaria, typhoid and murine typhus and scrub typhus, meningitis and encephalitis.? What is the public health importance of beriberi? How can the quality of anti-infective be improved?

5 Luang Nam Tha Xienglekok Phalanxay Xepon Salavan Attapeu

6 Causes of fever, epidemiology, diagnosis & treatment scrub typhus, murine typhus, leptospirosis, dengue, malaria, Japanese encephalitis virus, meningitis, sennetsu, bartonella, typhoid, melioidosis. Development & evaluation of Lao appropriate diagnostic capacity Fever and impact on pregnancy Antimicrobial resistance and treatment policy Infantile beriberi and hot beds Medicine quality

7 What causes non-malarial, haemoculture In Vientiane, hospitalised patients, blood culture negative Doxycycline responsive illnesses 39 % negative fever in Laos? Scrub typhus 16% Leptospirosis 10% Dengue 10% Murine typhus 10% Spotted fever 3% JEV 3%

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9 Dr Vilada Chansamouth Epi MSc LSHTM Pak Gnum Pregnancy cohort study Very high maternal mortality in Laos 405/100,000 live births Aims: to determine the incidence of febrile diseases in pregnant women and to investigate their causes and impact on mothers and babies A community based prospective cohort study N=1,000 in a rural district of Vientiane for 18 months As complete a diagnostic workup as possible, including flu with US CDC support at NCLE Using the experience of this cohort study we hope to extend to a larger sample size for a longer duration

10 Neglected health problems rural Asian tropics Toad poisoning Wild banana intestinal obstruction Infantile beriberi Noma = cancrum oris Mushroom poisoning Trichinosis Eosinophilic meningitis Fishing! drowning, cercarial itch, sepsis Motorbikes more dangerous than mosquitos? Pesticides and suicide

11 Diabetes in Laos Very few data anecdotally an increasing problem. Only one formally trained diabetologist ~18% of 504 people aged > 60 years failed OGTT in rural southern Laos (Suzuki et al. 2006) As part of large random survey of urbanisation in Vientiane City (2006) 2,031 adults aged >35 years, based on fasting blood glucose = 9.25% (Paboliboun 2006) How should diabetes be optimally managed in Laos?

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14 67% of Lao households operate farmland Average farmland/family 1.6 ha Rice farmed on 65% of holdings, only 14% are able to plant 2 crops/year 25% grow other cereals, 14% roots and tubers, 3 % legumes, 37% vegetables

15 Focusing our work on farmers health Aetiology and impact, economic and societal, of health problems Infectious diseases Nutritional diseases Back pain Accidents Diabetes Neglected issues such as bananas, toads, pesticides, mushrooms Health seeking behaviour, medicine quality, risk assessments Optimum public engagement Through three cohort studies of farming communities linked to the three Provincial Hospitals we support To inform future interventions

16 Thank you With many thanks for the support of the Government of the Lao PDR, Mahosot Hospital, many colleagues and the Wellcome Trust, University of Oxford & IRD